• Is our network structure affecting beneficiaries’ access to care?
• Are there large payment surges that may indicate fraud?
• Did program evaluation information support favorable health policy development?

Is our network structure affecting recipients’ access to care?

By using system alerts, quick problem analysis, and indicator reports that uncover what’s happening you can:

• Review health services, emergency room, and specialty and primary care physician utilization by geography, population group, or other defined category
• Determine if access issues can be overcome with provider and recipient education initiatives

Are there large payment surges that may indicate fraud?

By mining the data and conducting root cause analysis to determine why a pattern is occurring you can:

• Examine treatment and prescribing patterns to determine if waste, overuse, and potential abuse is present
• Identify systemic characteristics of fraudulent payment requests versus occasional coding errors

Did program evaluation information support favorable health policy development?

By using tracking, trend analysis, and benchmark comparisons to evaluate your solution you can:

• Trend year-to-year program results
• Study financial impact of care management programs
• Analyze program results quickly and sort to answer a variety of very specific utilization, program compliance, and health outcomes questions