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Health Plans: Overview
In recent years, the health plan industry has faced significant disruption due to initiatives like FHIR enablement, enterprise data strategy, technology modernization, provider performance and member experience. The COVID-19 crisis has accelerated many of these initiatives. Health plans are leveraging next-gen technology to improve time-to-value, create new markets and move ahead of competitors.
CitiusTech is well-positioned to empower health plans at every step of their digital transformation journey. We focus exclusively on delivering specialized solutions and services across the healthcare digital value chain – spanning interoperability, data & analytics, digital engineering, provider performance management and member experience management.
Our technology solutions for health plans are complemented by healthcare consulting solutions around digital innovation, core system performance, member engagement and regulatory compliance (HEDIS®, STAR).
*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)
Health plan & payer customers
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National plans are our customers
Blue Plans leverage our solutions
States where our solutions are being used
Health Plans: Focus Areas
Comprehensive solutions, accelerators and consulting services to drive digital innovation for payers.
Our deep understanding of interoperability (HL7/ CCDA/ FHIR) - cutting across health plan and provider applications (EHRs, HIEs, labs, interface engines) helps us deliver prebuilt solutions, accelerators and specialized consulting services for interoperability and payer-provider convergence.
Our FAST+ platform is a one-stop solution for FHIR implementation and CMS Interop Rule compliance, with a large set of pre-built components (APIs, parsers and data repositories). We work closely with leading payer organizations to drive next-gen interop initiatives, e.g., SMART on FHIR apps, NLP integration, Big Data and Cloud Computing.
With significant focus on healthcare data (providers, labs, post acute, home care, devices, SDoH, others), our solutions and consulting services enable health plans to help set up data and analytics solutions across population health, member analytics, Fraud, Waste & Abuse, provider performance analytics and HEDIS / Star ratings.
We have strong experience across real-time data processing pipelines, EDW, enterprise data lakes, parsers (CCDA, HL7, X12, FHIR), data modeling, Modern Data Warehouses (MDW) and data governance. We also help you develop next-gen analytics capabilities such as streaming analytics and AI/ML models for automated insight generation.
We help payers leverage next-gen technology and bridge the transformation from traditional monolithic technology architectures to modern event based digital architectures (Microservices, Cloud, etc).
Our portfolio includes next-gen application development & modernization, enterprise SaaS implementations, core payer system implementation and interfacing with third-party technologies (e.g., digital therapeutics, telemedicine, wellness, chronic care management). We also support organizations around intelligent automation (RPA), AI Engineering, MLOps and DevOps automation.
We combine performance management, analytics platforms and custom services to converge multiple trends (HEDIS, Stars, VBC, care management, population health) and take complete ownership of your provider performance needs.
- BI-Clinical is a leading analytics and reporting platform with 750+ pre-built KPIs / measures
- SCORE+ is a quality management platform for HEDIS® performance improvement.
- PERFORM+ is an integrated platform for value-based provider performance management
- SDE: Stars Decision Engine is an AI/ML based solution to drive CMS Star rating improvement
We build end-to-end solutions for mobile first engagements, consumer digital technologies, member self-service portals and omni-channel member management. We have an extensive portfolio of engineering, data management and analytics solutions that enable payers to transform member experience, create longitudinal member profiles and drive member self-management.
We also help drive next gen initiatives – including experience engineering using AI/ML, payment integrity solutions, member profiling and segmentation, performance analytics and member management operations (including CRM platform integration with key workflows like care gaps, member outreach).
Health Plans: Technology Platforms
CitiusTech helps customers accelerate innovation in healthcare through specialized solutions and next-gen healthcare technology platforms.
Our library includes a multitude of carefully chosen blogs, articles, webinars, etc. to help stay informed about the happenings of the industry
CitiusTech’s FAST+ Solution Now Utilizes IBM Cloud Paks to Help Increase Healthcare Interoperability2021
Santa Clara Family Health Plan Selects CitiusTech’s SCORE+ Platform for HEDIS 2020 Submission2020
Consult our professionals
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