Driving Convergence and Performance for Provider-led Health Plans

By establishing and managing their own health plans, provider organizations have a great opportunity to drive efficiencies, improve outcomes and lower costs of care. Provider-led Health Plans (Payviders) require a seamless vertical integration of services and a single, comprehensive view of member information, to build a robust care delivery model

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CitiusTech offers a suite of technology services and modular platforms that enable Payviders to accelerate innovation across key areas such as interoperability, care management, member experience, digital health, operational analytics and regulatory reporting. With over a decade of experience, working with leading payers and providers, CitiusTech is uniquely positioned to help Payviders achieve seamless integration, drive scalability and enable sustainable convergence.

 

Success Story: Improving Claims Adjudication Rate using AI / ML

Learn how a leading Payvider achieved a 90% claims auto-adjudication rate by leveraging CitiusTech’s AI / ML solution

CitiusTech’s Payvider Offerings

CitiusTech offers Payviders a unique combination of healthcare technology services and platforms to meet their needs on data, analytics, interoperability, applications and performance management. CitiusTech also enables rapid scaling, to meet the demands of a growing network, by efficiently utilizing existing applications and infrastructure.

Additionally, CitiusTech solutions are also backed by best-in-class management consulting expertise through FluidEdge Consulting (a CitiusTech Company), which focuses on strategy and operational excellence.

 

Enabling Integration and Interoperability

  • Interoperability across core applications – Core Admin, Care Management, Clinical Data Integration etc.
  • Data Quality and Enrichments to serve analytics and reporting needs

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Managing the Application Ecosystem

  • Application Implementations for new clients and upgrading to next-gen platforms
  • Multitenancy to provide secure access in shared instance environment

 

Driving Performance Management

  • Improvements in outcomes and efficiencies - across HEDIS and other quality / regulatory program scores
  • Enhance collaboration for clinical gap closure

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Driving Innovation (AI/ML – RPA)

  • Optimized Costs by leveraging a digital workforce for key manual processes
  • Embedded Intelligence into existing processes by leveraging predictive analytics and machine learning

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Case Study

Application Implementation & Maintenance for a Large Provider-led Health Plan

Learn how the client partnered with CitiusTech to scale-up its IT infrastructure and ramp-up to handle a fast-growing customer base

 

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