Enabling payers to innovate in the evolving healthcare market

CitiusTech: Health Plans

HEDIS/ STAR Reporting | Quality | Population Health Management | Payment Integrity

Emerging Health Plans Market: Innovation Challenges

The healthcare landscape in the US is evolving at a rapid pace, given the rising medical costs and mandates of healthcare reform. Today, it has become imperative for health plans to innovate in order to meet new market needs. CitiusTech, with its exclusive healthcare focus, is well-positioned to support health plans to succeed in this dynamic environment. We provide a unique set of healthcare technology services and solutions to help health plans accelerate innovation in healthcare.

CitiusTech: Offerings for Health Plans

With shifting healthcare trends and evolving regulatory mandates, health plans need to address rising costs, quality and care availability pressures to compete successfully in the marketplace.

Changing regulatory requirements have led health plans to invest in the development of structured applications and also ensure validation capability. They know that key to success lies in having a robust clinical and claims data integration and management in place. With the demand for quality care on the rise, health plans are increasingly becoming involved in improving providers’ clinical quality and performance so that they can meet their regulatory needs and reduce costs. Another key focus for health plans has been the use of mobile technologies for member engagement – to enhance outreach and member satisfaction.

With shifting healthcare trends

and reform mandates, health plans

need to address rising costs,

quality improvement and care

availability pressures to compete

in the marketplace.

CitiusTech leverages the power

of emerging technologies to

help health plans benefit from

key market opportunities around

care coordination, revenue

optimization, quality improvement

and regulatory compliance.

CitiusTech’s BI-Clinical

platform for healthcare

BI and analytics supports

ALL NCQA HEDIS 2016

& 2017 performance measures.

CitiusTech Offerings for Health Plans

Health Plans: Success Stories

• Population Health Management Advanced analytics solution to identify and monitor high-risk and high-impact cohorts

• ACO Management Integrated platform for hosted analytics for lives at risk across financial and clinical KPIs

• Payer Integration Implemented new payer relationships to support new regulatory requirements for a leading clearinghouse

• Care Coordination Development of next generation care coordination platform for leading provider using CRM, mobile and EHR technologies

• Care Management Development of patient self-management platform using mobile and social technologies for disease and wellness management

• Consumer Engagement Development of mobile-based application to enhance consumer experience for leading provider of wellness programs

• Clinical Reporting Implementation of BI-Clinical for advanced analytics and clinical reporting for leading MCO

CitiusTech: Services and Platforms

CitiusTech’s platforms and services enable health plans to plan, design, build and manage solutions to significantly enhance their business performance in all of these areas. Its platforms and services have been successfully leveraged by leading commercial and Blue Cross plans, accountable care organizations, as well as population health and wellness platform companies.

Services

Application Portfolio Services

Application development and maintenance; sustaining and re-engineering existing/ legacy applications

Enterprise Data Services and Analytics

EDW development/ enhancements; data management. DBA, data aggregation, data governance

Quality & Regulatory Reporting

Implement regulatory submissions on HEDIS, STAR, QRS; develop custom use cases, measures etc.

Payer-ProviderData Integration

Support for quality initiatives, revenue optimization, regulatory compliance; alternative payment models

ConsumerEngagement

Web, mobile and remote monitoring solutions; for enhanced consumer/ member engagements

Platforms

BI-Clinical (Healthcare BI and Analytics)

NCQA-certified; support for quality initiatives, regulatory compliance, risk management

H-Scale (Healthcare Big Data)

Accelerator for Hadoop and other big data technologies for data ingestion and real-time alerts

M-Verge (Mobile Health) Accelerator for developing apps, outreach alerts, health monitoring, biometric data integration

CQ-IQ(Cloud-Hosted Clinical Rules Engine)

Certified clinical rules engine for advanced CQM computation. HIPAA-compliant web services for easy integration with apps

Medictiv(Healthcare PredictiveAnalytics)

Patient data aggregation, risk analysis, gaps-in-care alerts and readmissions management

Princeton | Rochester | Dallas | Toronto | London | Dubai | Mumbai | Bengaluru | Singapore

www.citiustech.com

About CitiusTechCitiusTech is a specialist provider of healthcare technology services and solutions to medical technology companies, providers, payers and life sciences organizations, with over 2,700 professionals worldwide. CitiusTech’s services and solutions include healthcare software development, healthcare interoperability, regulatory compliance, BI/analytics, consumer engagement, care coordination and population health management. CitiusTech helps customers accelerate innovation in healthcare through a number of solutions and accelerators for clinical quality reporting, healthcare big data, cloud computing, mobile health and predictive analytics. With cutting-edge technology expertise, world-class service quality and a global resource base, CitiusTech consistently delivers best-in-class solutions and an unmatched cost advantage to healthcare clients worldwide.