Health Plans

Enabling you to improve member outcomes

We help health plans achieve sustainable operational efficiencies

The healthcare landscape in the US is evolving at a rapid pace, given the continuously rising medical costs and mandates of healthcare reform. Health plans today need to innovate to meet new market needs around revenue optimization, payment integrity, quality reporting, population health management and clinical data integration.
CitiusTech, with its exclusive healthcare focus, is well-positioned to support health plans to succeed in this dynamic environment. We provide a unique set of healthcare technology services and solutions to help health plans accelerate innovation in healthcare.

CitiusTech’s SCORE+ enables you to Standardize, Compare, Optimize, Report and Enhance your quality scores across regulatory areas like HEDIS and CMS STAR. Learn more about SCORE+ for HEDIS.

Health Plan & Payers, Managed Care Organizations, Disease Management Companies, Payer Services Organizations

Health Plans and Payers: Business Focus Areas

With shifting healthcare trends and reform mandates, health plans need to address rising costs, quality and care availability pressures to compete in the marketplace. CitiusTech, with its cutting-edge tools and technologies, enables health plans to define a strategic roadmap to achieve their key focus areas, design and build solutions to significantly enhance their business performance.

Healthcare Payer Technology Services, CitiusTech

Data Integration and Data Management

  • Standards-based clinical data integration (HL7, FHIR) from EHRs or HIEs, member/ provider portals; MDM and data quality services, aggregation services

  • Integration of clinical, claims and consumer data to effectively navigate healthcare reforms, regulations and contractual obligations

  • End-to-end data management services – EDW or data lake creation

  • Usability of clinical data across various systems and care settings (quality measures, HCC coding, predictive analytics)

  • Faster time-to-market enabled by standards-based accelerators - CCDA, FHIR, HL7, EDI X12, IBM UDMH

Clinical Quality and Performance Management

  • Clinical quality measures reporting (NCQA certified HEDIS®*, CMS Star, ACO, others), regulatory reporting for data submission
  • On-premise and cloud-hosted rules-based solution for advanced CQM computation – modular, user-friendly utility for rule definition, versioning, auditing and testing 
  • Provider engagement through clinical and financial insights as well as benchmarking
  • Real-time alerts and notifications, campaigns and other outreach initiatives
  • Population health management and tracking of individual high-risk members

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Mobile and Member Engagement

  • Integration of member engagement applications with enterprise applications (e.g. EHR, care management) to enable 360-degree view of members
  • Member risk stratification and engagement through real-time alerts
  • Wellness platforms, rewards and value based insurance design (VBID) programs
  • Leveraging consumer health devices, mobile devices and IoT for actionable insights
  • Design and development of workflow-driven member or provider engagement platforms to positively impact day-to-day operations

Application Development and Validation

  • Full-cycle application development, enhancement and sustenance across modern technologies
  • Design and development of enterprise platforms and architecture reengineering
  • Legacy application migration including cloud migration and sun-setting
  • Quality assurance, testing, verification and validation (V&V) services, including test automation
  • Supported by key practices such as Consulting, User Experience, Interoperability, Mobile, Big Data, Mobile and Analytics

Health Plans and Payers: Healthcare Technology Platforms

CitiusTech offers tools and accelerators that enable health plans and ACOs leverage clinical data to manage shared risk, optimize operational performance, engage consumers and enhance population care.

Healthcare Payer Technology Solutions, CitiusTech

NCQA HEDIS 2017 certified healthcare BI/analytics platform with 700+ clinical, financial, operational and regulatory KPIs - largest CQM library. Coverage of major quality initiatives – CMS Star, HEDIS, ACO, CMS/HHS risk scoring, MACRA, Meaningful Use & custom measures

Platform to accelerate mobile-driven member and physician engagement and IoT. Enables mobile strategy across apps and devices in conjunction with the enterprise data and capabilities.

Suite of predictive analytics tools and data science / statistical services to predict high-risk population, severity prediction, customer lifetime value prediction, geo-spatial segmentation, treatment compliance, accuracy of diagnosis etc.

Big data platform to accelerate big data strategy for master data management & automated analytics across claims, clinical & consumer data. Unique machine learning and unstructured data analytics capabilities.

ONC-HIT 2014 certified, HIPAA complaint cloud-hosted clinical rules engine for advanced CQM computation. Support for key regulatory measures – HEDIS, Meaningful Use, ACO-33, PQRS, etc.

Integrated AnalytiX
Integrated suite of enterprise platforms for data management, analytics and mobility to help healthcare organizations accelerate their quality, cost and care initiatives.