Start Making Smarter Decisions

Leverage  tested and validated data science applications to start answering critical questions

ML App Store

One solution, many data science applications provided. Edifecs data scientists perform initial research and design of Data Science applications targeted at a defined healthcare challenge. This design is trained and tested against representative data sets to validate the value of the solution and released to the customer to use.

Our Approach

With the speed and complexity of change in the healthcare ecosystem, it is crucial that health plans and providers seek flexibility and specificity with their analytic applications. Purpose-built, deep learning applications enable health plans to not only solve targeted challenges today, but will continue to deliver requisite, actionable insight well into the future.

Capabilities

Discover “What’s Weird” in your data

Machine Learning is ideal for discovering patterns in your claims data which indicate something fraudulent or wasteful is occuring.

  • Detect opioid abuse at the member, pharmacy and provider level
  • Identify fraudulent claims and possible contributing providers
  • Predict where wasteful spending may occur in the future

Understand your healthcare customer in ways you never thought possible

Understanding the healthcare customers experience is critical to providing good and complete care while controlling costs.

  • Engagement:  Drive member and plan care management engagement
  • Satisfaction:  Ensure member satisfaction and avoid abrasion
  • Predict member retention rates

Pharmacy data can be your window into the future

Pharmacy events are a primary predictor for future health events and costs.  Proper integration of medical and pharmacy data is critical to the success of healthcare prediction.

  • Medication Adherence:  Understand which members will be adherent to their medication and which will not
  • Atypical Prescribing:   Determine pharmacy utilization that does not align to diagnoses
  • Opioid abuse detection at the member, pharmacy and provider level

Improve Quality Metrics Performance

Quality programs such as Medicare Advantage Five Star, Exchange QRS and provider focused MIPS programs are increasingly determining reimbursement rates for health plans and providers.

  • Predict compliance to preventative care programs for colorectal cancer, breast cancer and diabetes
  • Predict adherence to prescription medications and improve outreach targeting
  • Proactively examine member satisfaction and recommend interventions

Accurate and Complete Encounters

Having high quality encounter data is critical to the  health of the health plan and members

  • Predict and fix encounter submission errors before they occur
  • Link Chart Data to Encounters more successfully and with less effort
  • Identify gaps in care and gaps in coding proactively
  • Predict future risks for members