Maximize Your Opportunity to Deliver Quality Care, Control Costs

Shift to member-focused programs using Certilytics library of 1,000+ clinical, financial and behavioral predictive risk scores to identify future risks and opportunities at the individual level, including social determinant of health (SDoH) factors.

Aggregate member level opportunities up to the population level using the Opportunity Analyzer and see in dollars the impact of executing different clinical programs based on outcomes or disease state.

Be confident you clinical program outreach strategies are reaching those members who are most likely to modify their behavior and improve their health using Certilytics’ member-level Target Index. This approach allows you to maximize your outreach and streamline operational and clinical resource efficiency.

Calculate the total realized cost savings associated with each existing program or strategy with Certilytics Impact Analyzer, an AI-powered program performance evaluation tool.

By going beyond vendor participation metrics, you can improve your plan design because you will know exactly which health and wellness programs are driving value – improving outcomes and lowering costs for your members and your organization.

Then, once your programs and strategies are in place, use the Certilytics Impact Analyzer to validate the total realized cost savings and ROI of your total cost of care strategies.

Certilytics proprietary Provider Practice GPT® offers in a new approach for evaluating providers and building the best networks by accounting for nuances in patient context to help predict patient pathways and measure provider treatment deviation.

Assess the cost and quality of your providers networks with Certilytics’ Network Optimizer and uncover opportunities for reducing expenses and enhancing preventative care strategies to avoid high costs later on.

Improve your value-based contracting initiatives with Certilytics’ Network Optimizer by looking at local and regional benchmarks to ensure your plan is getting the best value for the services being provided to your members.

Use Certilytics’ Claims Deep Representations’s GenAI model to accurately identify claims that deviate from expectations while accounting for the nuances of specific provider-patient interactions.