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® 2020 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 (a CitiusTech Company), 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.

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

FAST+ Solution

Boost FHIR adoption and data integration initiatives while complying with the CMS rule

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FHIR for HEDIS & Stars: Unanswered Questions

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Healthcare Technology Platforms

Healthcare Technology
  • Comprehensive solution for health plans to accelerate gap closure, minimize provider abrasion and improve HEDIS/ STAR performance
  • Support for real-time clinical alerts and data models like UDMH, OMOP, FHIM
  • AI and ML based scoring algorithms for Chase Intelligence, Healthcare Data Abstraction and HCC Risk Adjustment
  • SCORE+ for HEDIS enables health plans to generate near realtime HEDIS reports.
Healthcare Technology
  • 700+ pre-built KPIs across clinical, operational, financial, regulatory domains
  • Extensive regulatory coverage across HEDIS®, STAR, ACO, HCC, VBP, MIPS, PCMH, etc.
  • BIC-RMM: World's first Rules Management Module for rule definition and editing
  • BIC-Audit 360: Real-time audit and traceability of clinical measures, cohorts and rules
Healthcare Technology
  • Comprehensive healthcare data integration and management platform to drive enterprise data strategy
  • H-IQM: In-flight data quality monitoring through seamless integration with existing systems and 1,500+ prebuilt KPIs
  • HDP: Healthcare Data Pipeline is a state-of-the art solution to acquire, aggregate and transform healthcare data
  • Largest regulatory coverage HEDIS®, STAR, ACO, HCC, VBP, MIPS, PCMH etc.

Health Plans & Payers: Driving Clinical Value Chain Excellence

Health Plans & Payers: Driving Clinical Value Chain Excellence
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Quality Management

With specialized quality management solutions and services, CitiusTech helps health plans track clinical quality to enhance patient outcomes and achieve regulatory compliance.

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Interoperability & FHIR

CitiusTech’s FAST+ solution enables payers to lay a foundation by complying to CMS’ new interoperability rule and supporting them to achieve transformational change in their FHIR adoption journey.

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Technology Modernization

With strong expertise across microservices, Cloud migration, integration, and serviceability, CitiusTech helps payers achieve technology modernization through next-gen product engineering and implementation services.

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Stars Optimizer

Drive overall business transformation for Medicare Advantage plans by leveraging AI/ML driven solutions to improve CMS Star ratings

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RPA for Health Plans

CitiusTech has a dedicated team of RPA experts with extensive healthcare automation experience. We help our customers accelerate their RPA inititiaves through a combination of best-in-class RPA expertise, partnerships with leading RPA products, and an extensive libraries of pre-built accelerators and frameworks.

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