HEALTHCARE PLAN ANALYTICS

Healthcare reform and changing demographics have driven significant changes for payers. In this changing environment, EXL Analytics enables payers to expand their business, manage and improve health care quality while continuously reducing medical and administrative costs. EXL’s leading-edge analytics and data management solutions combine years of industry knowledge and technology expertise to consistently deliver positive business outcomes for clients.

ACTUARIAL SUPPORT

  • Pricing
  • Reserving
  • Underwriting

PAYMENT INTEGRITY

  • Overpayments
  • Fraud analytics
  • Medicare reimbursement
  • Hospital bill audits

INFORMATICS

  • Plan sponsor information and consulting
  • Program evaluation
  • Provider performance management
  • Data Warehousing & BI Reporting

ACCOUNTABLE CARE

  • Network/contracting
  • Financial analytics
  • Quality of care
  • Patient experience
  • Regulatory compliance

LEGAL SERVICES

  • Litigation propensity
  • BAA analysis
  • HIPAA reporting

MARKETING

  • Direct marketing
  • Digital content development
  • Database integration and management
  • Campaign management
  • Predictive modeling

CARE MANAGEMENT

  • Risk assessment and member targeting
  • Evaluating effectiveness of wellness and CM program

QUALITY AND COST OF CARE

  • HEDIS/STAR ratings
  • Member sentiment analysis
  • Utilization patterns e.g. knee replacement, ER, imaging
  • First call resolution

EXL has built a state-of-the-art analytics hub for a leading national payer to support multiple Commercial and Government businesses, and provide access to expertise in multiple technologies. Key benefits delivered include:

 

SIGNIFICANT MEDICAL COST REDUCTION

 

INCREASED PROCESS EFFICIENCIES THROUGH AUTOMATION

 

INCREMENTAL PREMIUMS THROUGH MARKETING CAMPAIGNS

CASE STUDIES

 

ANALYTICS IMPACTS HIGH COST OF OVERPAID CLAIMS FOR HEALTH INSURER

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CURBING THE COST OF HEALTHCARE, REDUCING CLAIM OVERPAYMENTS FOR PAYERS

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IMPROVING HEALTH OUTCOMES THORUGH MEMBER ENGAGEMENT, CONTROL COSTS WITHOUT SACRIFICING QUALITY OF CARE

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TOTAL POPULATION HEALTH MANAGEMENT 2.0

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THE ROLE OF DATA FEDERATION IN HEALTH PLAN REVENUE OPTIMIZATION

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READY TO LOOK DEEPER?

CONTACT OUR ANALYTICS LEADERSHIP TEAM.

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