This application applies evidence-based clinical rule sets and advanced mathematical processes to claims, membership and other data (lab, health risk assessment, etc.) to identify high-risk members and rank them by need.  Use these clinically-based forecasts to allocate resources efficiently and intervene before adverse outcomes occur and dollars are spent. Results are presented in an easy-to-use web interface. A few mouse clicks generate a list of members with diabetes and a profile of Impact Opportunities - areas that provide the greatest potential for intervention and management. Standard reports present clinically-relevant data about expected inpatient, pharmacy, and ER use, along with total expense projections.

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Risk Navigator Performance provides retrospective and prospective utilization profiling information for providers and facilities. Provider and facility performance can be measured against national and regional benchmarks. Key information includes Case Mix Index, Efficiency Index, and Episode evaluation of potential savings, and more. .

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Risk Navigator Financial provides actuarial and underwriting reporting functionality, cost predictions, and modeling flexibility. Historical trends in cost, utilization and risk by group and renewal date, combined with predictive capabilities, make this a very powerful tool for Actuarial and Underwriting teams.

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Risk Navigator Provider provides clinicians and/or office managers with the ability to retrieve information for a specific patient, obtain a list of all patients' evidence-based medicine compliance, and review utilization performance. Disease and diagnosis reports at aggregate and individual patient levels are also available.

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Risk Navigator Guidelines effectively engages health plans, care managers, providers, and consumers by communicating where potential gaps in care and/or medical errors may exist
at a time where precautions can be taken to prevent or mitigate the concern.

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Complex Care Management™ is a multifaceted solution that reduces pharmacy costs and increases quality of care for members. The program is a plan-specific quality initiative based on evidenced-based medicine that focuses on educating health plan providers about the optimal use of behavioral health medications for health plan members via mailings and face-to-face detailing visits by clinical pharmacists.

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MTM360 is a comprehensive medication therapy management (MTM) solution based on award-winning analytics and comprehensive documentation systems. The offering grants Part D benefit sponsors the ability to identify MTM members who meet client-specific requirements as well as stratify patients using CMS mandated rules. Additionally, sponsors can manage patient encounter documentation, reporting and faxing to address program requirements.

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