HEALTHCARE ANALYTICS

Health reform focuses on mitigating lower risk populations to higher levels of clinical and financial risk. This approach includes maintaining healthy behaviors as well as coordinating care for chronic condition management. With renewed focus on outcomes and care coordination, along with value-based payment methodology on the rise, the emphasis shifts to rewarding quality as opposed to quantity of services. Leading health plans are now leaning on data and analytics to monitor outcomes, gain insight and predict future states.

Our more than 1,500 data scientists provide a wide range of solutions to enable better clinical decision-making, improve member care, manage risk and drive better market access. Our award-winning data scientists and analytics experts enable market-leading, next-generation care management decision support, patient-centered and consumer-centric health models, and actionable insights to drive higher efficiencies and cost containment.

CAPABILITIES

  • Actuarial
    • Pricing support, durational analysis
    • Reserving support
    • Actuarial and underwriting tools development
    • Regulatory reporting
    • Rating support, benefit indexing
  • Claims
    • Claims overpayment identification and recovery
    • Rework evaluation and reduction strategies
    • Forecasting and resource management
    • Fraud detection
    • Litigation propensity
  • Informatics
    • Plan sponsor information and consulting
    • Program evaluation
    • Provider performance management
    • Custom informatics
    • Data warehouse & BI reporting
  • CRM and Marketing Analytics
    • Developing and maintaining comprehensive data asset
    • Acquisition, up-sell, cross-sell and retention campaigns
    • Assessing effectiveness of marketing campaigns
    • Health data management
  • Medical Cost and Care Management Analytics
    • Risk assessment on members
    • Forecasting cases for hospitalization
    • Predicting length of stay
    • Reduce preventable services
    • Evaluating effectiveness of wellness and DM programs
    • Network management support
    • Care management reporting
  • Operational Effectiveness
    • Forecasting
    • Capacity planning
    • Service center management
    • Process optimization
    • First call resolution
    • Root cause analysis

THOUGHT LEADERSHIP

Assessing Risk of Hospitalization in Member Population

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CASE STUDIES

A large U.S. provider of healthcare, dental, pharmacy, and disability insurance was facing overpaid claims of more than $500 million annually and turned to EXL to identify and validate overpaid claims.

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A nationally recognized healthcare institution leveraged EXL analytics to improve the performance of a kidney transplant program and install a framework for ongoing quality control.

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RECOGNITION

Excellence in Analytics 2015
- ‘Preventive Hospitalization’ Solution recognized at NASSCOM Big Data & Analytics Summit

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The ability to assess health risk early and then provide appropriate outpatient care can prevent hospitalizations or at least prevent complications.

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READY TO LOOK DEEPER?
CONTACT OUR HEALTHCARE LEADERSHIP TEAM.

 



GET IN TOUCH WITH US

Mail

lookdeeper@exlservice.com

Address

280 Park Avenue, 38th Floor

New York, NY 10017