Program Integrity and Analytics

Program integrity analytics that deliver measurable results

Clinical data analytics, business intelligence analytics (including fraud, waste, and abuse), and population health analytics are becoming critical components of healthcare IT programs. There is also an increasing shift towards predictive analytics, since it can be harnessed to prevent disease and drive efficiencies throughout our rapidly evolving healthcare system. Health data analytics provide critical insight into member health status, behavior, and coverage decisions. It can also transform a provider from reactive to proactive, and keep costs under control while providing the best care possible.

Cognosante is a leader when it comes to designing and deploying analytics to transform healthcare. Our eSante® Analytics is a set of Medicaid-focused tools and methodologies that provide meaningful data insight, analysis, and strategic interoperability facilitation within the state IT enterprise.

Our analytics capabilities help states:

Better oversee managed care organizations through utilization tracking and network adequacy measurement
Derive optimal value from Health Information Exchange (HIE)
Maintain program integrity and minimize fraud, waste, and abuse
Manage data integrity and standards, reconciliation, and remediation
Measure quality and outcomes required by state innovation waivers and payment reform initiatives
Track spending trends and expenditures
Predict and model future spending

Key features:

Analytical applications specifically designed to provide meaningful data analyses and visualizations to Medicaid agencies
Platforms for population health analyses and alternative payment methodologies
Workflow management solutions to track and report on program integrity cases, audits, and analytical reviews
Pipeline services that support the interchange and transformation of X12 and HL7 message types into XML and normalized formats

Integrity analytics in action

Cognosante helps resolve application and eligibility issues to aid consumers in obtaining health insurance

Cognosante data reconciliation and standards expertise drives resolution of more than a million health insurance marketplace consumer inquiries

Cognosante helps uninsured enroll for health coverage under ACA

eSante® Analytics Medicaid Managed Care Insights

is a suite of analytic tools that help state directors obtain the best possible value from Medicaid managed care programs.

Key features:

Analytics tools, reports, dashboards, and data visualizations (including geographic information system) that support data-driven decision-making and increase managed care organization (MCO) transparency and accountability
Expert policy and operations services to assist state Medicaid programs as they implement managed care changes
Data collection, data warehousing, data management, and data sharing services
Assistance meeting Centers for Medicare & Medicaid Services (CMS) reporting requirements

Cognosante wants to work with you

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