Health Plans

Addressing Challenges Around Member Outcomes, Risks and Regulations

With rising costs of care and fast-changing regulatory mandates, health plans need to invest in technology solutions that drive value-based care. They face multiple challenges around risk stratification, population health, accountable care and regulatory challenges like HEDIS® and STAR.

CitiusTech is well-positioned to help health plans drive clinical value chain excellence. CitiusTech offers a comprehensive suite of services, platforms and solutions across a wide range of payer needs. Its BI-Clinical platform for healthcare BI / analytics is NCQA certified for all HEDIS 2019 performance measures. CitiusTech’s SCORE+ for HEDIS is an end-to-end suite for real-time HEDIS reporting, provider collaboration and accelerated gap-closure.

CitiusTech also provides best-in-class management consulting expertise through FluidEdge Consulting, which focuses on strategy, operational analysis, regulatory compliance, quality programs, technical evaluation and project management. Through a strong health plan network, FluidEdge has access to a large number of health plan-focused resources with knowledge of core claims processing systems, provider data management systems and care / medical management systems.

Success Story

BI-Clinical Helps Leading Blues Plan Achieve Near Real-time Quality Reporting

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Driving Clinical Quality & Outcomes with a Robust Clinical Data Framework

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Health Plans & Payers: Driving Clinical Value Chain Excellence

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

Healthcare Technology Platforms

Healthcare Technology
  • Comprehensive solution for health plans to accelerate gap closure and improve HEDIS scores
  • Support for real-time clinical alerts and data models like UDMH, OMOP, FHIM
  • AI and ML based scoring algorithms for Chase Intelligence
  • SCORE+ for HEDIS enables health plans to generate near realtime HEDIS reports.
Healthcare Technology
  • 900+ pre-built KPIs across clinical, operational, financial, regulatory domains
  • World's first Rules Management Module for rule definition and editing
  • Supports 4,500+ provider locations
  • 550,000+ physcians using this solution
Healthcare Technology
  • Platform to accelerate healthcare data interoperability and data management
  • Portability across platforms, deployment models and Hadoop distributions
  • Data Stream Analyzer: Library of over 1,500 data quality and standardization rules
  • Largest regulatory coverage HEDIS®, STAR, ACO, HCC, VBP, MIPS, PCMH etc.