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The Health Plan Market Has Evolved

As the healthcare marketplace evolves, proactive health plans are implementing innovative strategies to manage member risk, streamline operations and manage the health of their enrolled population while shifting from fee-for-service to a value-based payment model.

Partnering with SpectraMedix empowers health plans to do this with the advanced data integration capabilities and actionable insights they need. Our enterprise-level business intelligence solutions support HEDIS and Star Rating performance improvement initiatives, identification of gaps in care, risk adjustment and risk scoring, implementation of coordinated care models and executing contracts with providers.

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    Data-Driven Capabilities for Payers to:

    • Identify and manage chronic, at-risk patients and rising-risk patients  
    • Create a universal member identifier (EMPI)
    • Track members’ compliance through pharmacy claims, billing files, test data and other encounters 
    • Analyze trends across member populations 
    • Integrate social determinants of health into patient tracking
    • Manage performance against quality, utilization, and financial metrics and benchmarks
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Data Management

Your data, your way. Tell us what you want to achieve, and we’ll use your data and our IT expertise to get there.

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Regulatory Outcomes

SpectraMedix has everything needed to assist your reporting goals: federal, state and commercial initiatives.

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Data Normalization & Storage

Is your data coming from multiple sources and formats? SpectraMedix is able to aggregate,  normalize and store data for a range of business intelligence uses.

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