Risk Adjustment

Veradigm Utilization Analytics

Clearinghouse + EDI

Delivers visibility needed to monitor and manage Key Performance Indicators that tracks utilizations and costs associated with contract and provider groups.

Reduce Costs and Avoid Inappropriate Utilization and Waste While Improving Quality of Care

Today’s healthcare providers are under significant pressure to control costs for their patients. Veradigm Utilization Analytics, an add-on to Veradigm Risk Adjustment Analytics delivers visibility needed to monitor and manage Key Performance Indicators that track utilization and costs associated with contracts and provider groups. With Veradigm Utilization Analytics, accurate action can be taken to achieve improved and equitable health outcomes, resulting in an overall lower total cost of care. Veradigm Utilization Analytics supplies health plans and providers with the analytics and insights needed to identify targets for improvement. It empowers clients to take actions that can lead both to better healthcare and to improved financial outcomes.

Optimize Your Contracts, Provider Groups, and Programs By:

  • Reducing inappropriate Emergency Department utilization
  • Improving 30-day unplanned readmission rates
  • Decreasing cost-of-care
  • Minimizing revenue leakage due to services referred out-of-network
  • Accessing program performance analytics at a single location
  • Tracking PMPM performance to historical benchmarks
  • Utilizing Network Leakage analytics by claim type, specialty, and facility

Learn More about Veradigm Utilization Analytics

Track Utilization and Costs Associated with the Delivery of Your Programs

Tracking utilization (emergency department, inpatient, and readmissions) and minimizing lost revenue due to services occurring out of network is vital to high-performing value-based programs. Providing visibility into the types of services occurring out of network also assists in better contract and network design in the future.

Veradigm Utilization dashboards provide a spatial representation of where out-of-contract and out-of-network services are occurring, along with the associated specialties and locations. These details can be used to fill holes in your specialty provider network and/or geographic coverage to reduce leakage.

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