The Health Plan provides quality actuarial and risk management solutions for insurers, self-insured organizations and other entities that are financing risk.
Health care analytics incorporated into the managed care process improves the quality and delivery of care and drives efficiency, productivity, and financial performance.
The CCGroup Marketbasket System™ is our analytical software that provides nationally established quality metrics and enhances our care management programs by assisting in developing interventions for those most in need and directing cases to the appropriate care management team member. This software allows us the ability to identify opportunities for improvement in patient care and provider practice patterns. The tools in this software provide predictive scoring and physician ranking based on statistically sound analysis. With this knowledge, The Health Plan can quickly identify actionable risk factors to support clinical care intervention. The provider scoring component of the software is used to improve efficient and effective care in our provider networks.
The STARSSentinel™ software provides us with in-depth analysis on provider billing patterns in an effort to quickly and easily identify possible fraud, waste, or abuse. This information allows the plan to actively engage with a provider regarding billing patterns and adjusts those patterns when appropriate. Every effort is made to educate providers while achieving the highest levels of quality and cost-effective care to our members.
The newly formed business intelligence unit is actively involved in providing relevant and actionable data for all departments within The Health Plan. This unit provides analytical support to our clients to help them achieve maximum cost-effectiveness while providing quality care to their unique population.