Get the clarity you need to drive down your medical loss ratio and improve care
Verisk Health works with health plans to bring clarity and focus to efforts to control financial and clinical risk, revealing opportunities to lower medical and pharmacy claims costs, improve the quality of care, and increase member and provider network satisfaction.
Powerful analytics combined with focused guidance
With our neutral, independent perspective, we get to the heart of your data using decision analytics driven by the industry standard of risk and quality assessment models. Additionally, our experts' deep understanding of clinical and financial risk provides insight into your data, outlining clear courses of action and opportunities for improvement.
Provide accurate, consistent results to your entire healthcare community
Verisk Health also helps health plans to meet the challenge of delivering accurate, consistent results and reports to diverse users throughout the enterprise. We connect your entire healthcare community including a broad constituency of stakeholders outside the plan so that everyone shares the same picture.
Solutions that meet your business needs
From effectively managing your disparate sources of data to complying with new regulatory requirements to delivering the most relevant clinical information to your care managers' desktops, Verisk Health will assess your business challenges and provide an integrated solution to meet your specific goals.
Verisk Health supports health plans with solutions for:
Cost Containment
Our solutions provide actionable information that you can use to define cost trends and bring down the rising claims costs in your population.Proactive Care Management
Determine the best proactive strategies for increasing quality of care and reducing costs in delivering disease and case management services. We provide solutions to help you stratify populations, identify members at risk, and inform outreach programs with evidence-based clinical guidelines and gaps-in-care analyses.Employer Reporting
Our state-of-the-art solutions simplify employer reporting by providing web-based access to executive reporting tools, real-time analytics and custom dashboards – enabling you to easily produce glossy reports, executive summaries, and more.Standardized Internal Metrics & Technology
Our fast, efficient technology offers better support for internal stakeholders, provides standardized metrics and ensures portability of technology across departments.Transparent Quality Measurement
More efficiently and transparently measure the quality of program and provider performance to identify gaps in care and quantify improvements.Provider Management and Pay for Performance
Gain insight into the performance of the provider network, provide information that facilitates building the network, and better connect the provider to the plan for clearer communication. Develop fair and efficient provider reimbursement and payment methods and models.Underwriting
Ensure that your plan is on the path to profitability with flexible, industry-leading tools for underwriting and reserve setting. Integrate our risk adjustment solutions to add power to your proprietary tools – or use our toolset if you prefer a turnkey solution.Premium Setting
Our risk models give you a clear understanding of the illness burden, allowing you to develop strategies for setting premium rates for competitive bidding and profit optimization and giving you the information you need to set reserves, as well as adjust rates when new data trends emerge.Value Demonstration
Effectively demonstrate the value and excellence of your services to clients and employer groups. Use our state-of-the-art reporting to help secure renewals and win new employer contracts.HRA and Claims Data Reporting
Utilize our data importing and reporting tools to leverage HRA and claims data to gain insight on total health and productivity measures.HEDIS® Solutions
Whether you are required to submit HEDIS rates or would like to add HEDIS measures to your strategic initiatives, our NCQA-certified solutions can help. We help you increase the efficiency of HEDIS reporting and get the clarity you need to better gauge progress and inform business decisions.
Products and services we offer for health plans include:
Sightlines™ Enterprise Analytics »
Highly flexible, enterprise-level platform that excels at reporting and exposing data via the Web – to connect your entire healthcare community.
Sightlines™ Medical Intelligence »
Data analytics and reporting platform that supports clinical outreach and pinpoints opportunities for medically sound, financially effective interventions – at both the patient and population levels.
Sightlines™ DxCG Risk Solutions »
The industry standard of risk adjustment and prediction engines, used to analyze and quantify both financial and clinical risk.
Sightlines™ Performance Measurement »
Industry-leading toolset that provides NCQA Certified HEDIS Software℠ to address quality and performance risk, and facilitates compliance with HEDIS® requirements.
Analytics and Technology Consulting Services »
Verisk Health's medical, financial and technical experts are uniquely qualified to help you develop strategies for cost containment, proactive care management and other needs your clients may have.
For additional information, please contact us.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Certified HEDIS Software℠ is a service mark of the NCQA.
: