Turn Risk into Opportunity with Predictive Analytics

No predictive analytics company understands the complex needs of healthcare payers like Certilytics. We all came from healthcare backgrounds, and we know first-hand what analytics and reporting look like at payer organizations—large vendors with exorbitant prices, a clunky user experience, old data, and even older products. In 2013, we partnered with Anthem and Express Scripts (now part of EvernorthSM) to challenge the status quo in predictive analytics. Together, we proved better healthcare analytics is possible by building a sophisticated, highly scalable, and battle-tested analytics ecosystem.

We bring years of experience helping health plans win new business, retain existing business, and better manage their member populations—generating millions in new revenue. This is all driven by Certilytics’ proprietary Opportunity Framework, which shows you the value, in dollars, of medical management and provider engagement strategies. The framework aligns clinical and financial stakeholders on the design of new programs, the allocation of clinical resources and treatment decisions, and the development of novel, risk-based pricing and reimbursement strategies.


Ready to learn how you can to differentiate yourself in an increasingly value-focused ecosystem?

Read White Paper

Certilytics Supports:

  • Cost & Utilization Management
  • Population Health/Value-Based Care
  • Data Management
  • Provider & Network Optimization
  • STARS/HEDIS Improvement
  • Risk Management
  • Stop/Loss and Fully Insured Underwriting
  • Payer & Reimbursement Management
  • Proprietary Model Development
  • Digital Research

Case Study

One national insurer optimized its medical management programs with the Certilytics Opportunity Framework, leading to millions in year-over-year savings. Moving from retrospective reporting to prospective insights, the insurer did a better job identifying members not only with the greatest financial exposure but with the highest likelihood of changing their behaviors in response to clinical outreach. This resulted in a shift away from inpatient hospital admissions toward preventive services such as outpatient PCP visits.

Read more about how this insurer saved millions—Download our case study now!