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  • Health Plans and Managed Care
Health Plans
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Health Plans - Overview

Health Plan Market Focus

  • Health Plans & Payers
  • Managed Care Organizations (incl. ACOs)
  • Disease management companies
  • Payer services organizations 

Market and regulatory changes in recent years are driving health plans to collaborate with provider organizations and effectively leverage both clinical and financial information to address these changes. As a global leader in healthcare technology, CitiusTech has deep expertise in clinical data and related technologies - EHR, HIS, healthcare information exchanges (HIE), medical imaging, ancillary systems (labs, pharmacy) and other clinical systems. In addition, our strong expertise in health plans and managed care workflows enable us to help our clients leverage emerging technologies and build competitive advantage. 

Healthcare Technology Services

Healthcare Software Engineering: Enterprise-grade application development and sustenance of legacy payer / claims applications. Development of solutions to manage ACOs / shared risk entities, patient and provider engagement across web, mobile and social platforms for outreach and patient self-management.

Healthcare BI & Analytics: Wide range of BI and analytics services, including development of scorecards and dashboards to track clinical quality measures, benchmark physician and provider performance, support regulatory requirements like HEDIS, P4P, ACO-33, etc. 

Healthcare Interoperability: Aggregation, mapping and standardization of payer and provider data, across multiple operational, financial and clinical systems. Supports large interoperability needs (e.g., HIEs, ACO networks), including development of adapters, interfaces and 24x7 network monitoring.

Specialized Services: Healthcare domain and technology consulting to enhance payer-provider integration, e.g. shared risk, care coordination, population health, regulatory compliance (HEDIS, Medicare Star, ACO, etc.). Specialized User Experience (UX) services to help payers conceptualize and build state-of-the-art consumer engagement, care coordination and reporting solutions.

Healthcare Technology Solutions

BI-Clinical: Pre-packaged as well as custom solutions for payer analytics and reporting, e.g., HEDIS, population viewer, patient risk profiling, disease registries and evidence-based protocols. The BI-Clinical Rules Engine can be effectively leveraged for rapid development of proprietary clinical algorithms and risk stratification.

H-Scale: Big data and Hadoop accelerator to aggregate massive and diverse healthcare data sets across structured and unstructured data sources to drive key health plan use cases including claims fraud detection, clinical data analysis for improved outcomes, member engagement, HEOR, patient recruitment and retention, etc.

M-Verge: Mobile health platform for accelerated development and deployment of health use cases such as patient self-management, remote health monitoring, social listening, biometric data integration and HIX enablement. Highly scalable cloud-based platform for enabling efficient and cost effective roll-out across large member population.

Medictiv: Suite of predictive analytics tools and services assisting organizations analyze large clinical and financial data sets, perform risk analysis, benchmark patient cohorts, identify comorbidities & gaps-in-care, and optimize key metrics like length of stay, denials and readmissions.

To learn more, please contact us by email at or call us at +1 (877) CITIUS1.
Case Studies
Brochure: CitiusTech Health Plans Practice
BI-Clinical: Elevate Care Quality for Higher STAR Ratings
BI-Clinical: Improving HEDIS Scores to Enhance Value Based Outcomes
Brochure: BI-Clinical: Advanced BI & Analytics for Health Plans
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