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.
Assessing Risk of Hospitalization in Member Population
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.
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.
Excellence in Analytics 2015
- ‘Preventive Hospitalization’ Solution recognized at NASSCOM Big Data & Analytics Summit
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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