Understand and Reduce Risk in the Medicare and Medicaid Population

Identifying members with complex medical needs is a challenge in any market, but especially in the public sector. Verisk Health provides flexible solutions to meet the needs of public sector payors seeking to identify, manage and minimize clinical and financial risk associated with providing healthcare coverage to the Medicare and Medicaid populations. Additionally, our powerful tools can help Medicare Advantage plans and Medicaid Managed Care Organizations to present the most competitive bids based on reliable, credible analytics and risk adjustment.

Powerful, flexible software solutions

Verisk Health solutions support public sector payors by providing market-leading analytics that identify any potential understatement of clinical illness that may increase premium revenue. Our technology platform helps identify high-risk members, track healthcare metrics against benchmarks and provide care managers with immediate access to clinical and financial data.

Ongoing, focused guidance

For Verisk Health’s staff of experts, healthcare risk management is more than just crunching numbers. We are committed to providing focused guidance to public sector payors who need neutral, dynamic and innovative ways to approach healthcare data analysis.

Verisk Health supports public sector payors with solutions for:

  • Cost Containment
    Better define cost drivers, increase efficiency, and define improved cost control strategies for public health coverage programs.
  • Optimizing Quality of Care
    Determine the best intervention options for increasing quality of care and reducing costs in delivering disease and case management services.
  • Improving Beneficiary and Recipient Health
    Determine how best to improve health and enhance the quality of life for beneficiaries / recipients in your population.
  • Fraud Prevention
    Identify and prevent waste, abuse and fraud in professional healthcare claims.
  • Reimbursement, Payment and Fund Disbursement
    Develop fair and efficient reimbursement, payment and fund disbursement methods and models.
  • Population Analysis
    Analyze aggregated healthcare data across entire populations and special populations.
  • Informing the Legislative Process
    Provide support for making data driven and informed healthcare legislative decisions, as healthcare reform begins to move forward at the state level.

Products and services we offer for public sector payors include:

Sightlines™ Medical Intelligence »

Our data analytics and reporting platform supports clinical outreach and pinpoints opportunities for medically sound, financially effective interventions – the perfect solution for helping public sector payors to contain costs and improve care.

Sightlines™ DxCG Risk Solutions »

The industry standard of risk adjustment and prediction engines with our new payment and performance solution module is used to analyze and quantify both financial and clinical risk. Use it as a stand-alone tool or inside our Sightlines Medical Intelligence platform.

Sightlines™ Performance Measurement »

Use our industry-leading toolset to streamline your HEDIS® reporting and address quality and performance risk.

Analytics and Technology Consulting Services »

Verisk Health's medical, financial and technical experts are uniquely qualified to help you develop strategies for proactive care management, reimbursement models, performance measurement and other specific needs.

For additional information, please contact us.