Reduce Cost and Improve Network Performance

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For Payers That Want to Make Data-Driven Decisions

To succeed in today’s data-driven world, Payers need advanced analytics with actionable insights to reduce costs and improve outcomes for their members.

We help you gain market intelligence, find the right providers and specialists to partner with, and understand risk for your patient populations. Our solutions provide analytics and insights derived from our access to comprehensive Medicare, Medicaid, and Commercial datasets – linked claims and encounter data for over 130 million longitudinal beneficiaries. You can build and optimize your network, evaluate your performance against the rest of the market, and take action to increase your footprint.

Remain competitive and answer important business questions like: How do I compare against my competitors? How can I find the right providers to match my patient population? How do I track referrals and reduce low-value care?

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Understand provider performance at provider, practice, and specialty levels and identify high performers for special contracting arrangements. Use our Provider Performance Index to benchmark providers against similar providers in your regions, or to find novel ways to improve quality and reduce the cost of care.

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Measure the prevalence of configurable chronic conditions, compare costs and co-morbidities, identify key pockets of care and facilities, and track patient journeys and care pathways. Answer questions like: What clusters of conditions will impact market expansion? Who are the influential local providers in my region?

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Drive healthcare improvement by accelerating the adoption of open standards that enhance the exchange of healthcare data. We help Payers advance adoption of modern, open interoperability standards by creating consistent data standards for the FHIR API specifications.

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CareJourney and Interoperability
CareJourney and Interoperability

“CareJourney’s analytics have allowed us to identify high-performing providers and map them to the right patients that need the most care. We were able to successfully expand our network into new geographies and evaluate network performance and adequacy over time.”

Chief Strategy and Growth Officer
Large Regional Payer

This guide presents an overview of tools for implementing network selection, management, and optimization using CareJourney’s Provider Performance Index for cost and outcomes.

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A growing Health Plan used CareJourney to pinpoint the best market participants, expand to new markets across the nation, and achieve high network integrity between providers, groups, and facilities.

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CareJourney provided utilization patterns and referral views to understand which Specialists were already being utilized heavily by existing in-network primary care providers.

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See It For Yourself

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