Collaborative Healthcare Solution

The project requires Ideation to collect clinical and claims data for each encounter, validated against a specific set of rules, additional eligibility checks executed with the data and finally deliver Analytical Insights to its end users.

Major Impacts:

  1. Over $500,000 in out of-network utilization prime for possible redirection to in network services and/ or network expansion opportunities
  2. More than $39,000 in retail prescription refill costs that could be redirected to lower-cost, mail order channels
  3. 240+ employees taking brand name prescriptions that could switch to a generic and reduce medication costs
  4. 200+ employees with high risk conditions that had not seen their primary care physician in the past 12 months for follow up and case management