Payers
PotentiaMED’s team has extensive consulting and industry experience with assisting payers in dealing with the increasing pressure to make healthcare more affordable, retain existing members and acquire new members, while enhancing services and increasing quality of patient care. In such an environment, success depends on capturing, integrating, analyzing, and acting on information at the right time. We have a proven track record in delivering measurable results for our clients in payer organizations by solving complex information challenges in an increasingly customer-centric environment.
Working with Payer and Third Party Administrator organizations we’ve proven that we have a solid understanding of your issues and can quickly establish innovative BI and IM solutions to improve your business performance. What's needed most is a partner that understands your complex challenges and will help you develop an intelligence platform that crosses the organization by leveraging your data assets. Our clients benefit from our key capabilities in data integration, which is the most challenging issue in providing better healthcare and increasing business performance.
We can help you develop and deploy a reliable, accurate, scalable, and integrated analytics platform leveraging ‘silos of intelligences’ from data related to employer groups, membership, product, facility, provider networks, outcomes and claims, actuarial, underwriting, human resources, and marketing and sales. An integrated platform enables your organization to manage complex business issues such as cost containment, enhancing services, litigation, regulatory compliance, benefit mandates, medical fraud, and sales and marketing performance.
We offer business intelligence, analytics, predictive analytics, performance management, and information management solutions to improve operational efficiency and business performance in the following areas:
- 360 Degree Member view
- Actuarial
- Early Fraud Detection and Prevention
- Medical Management and Healthcare Informatics
- Disease Management and Predictive Modeling
- Provider Analysis and Management
- Underwriting Profitability and Inventory Management
- Utilization Review and Quality Management
