Improved Health Plan Performance Through Unified Data Intelligence

Challenge

A mid-sized state health plan needed a scalable approach to close care gaps, recapture HCCs, and improve utilization performance across a network of more than 10,000 healthcare providers. With its existing incentive program ending in 2021 and new HMO and PPO products scheduled for launch in early 2022, the organization required strong quality, risk, and utilization reporting to support corporate leaders, provider engagement teams, and IPAs.

Story

As the plan introduced new product lines, internal teams struggled with fragmented reporting, inconsistent provider engagement data, and limited visibility into key quality and risk metrics. They needed a unified intelligence environment capable of delivering timely, actionable insights for both enterprise leadership and field-level provider groups.

Solution

A comprehensive analytics and reporting platform was deployed to support the plan’s end-to-end quality, risk, and utilization requirements.

The initial rollout included 29 custom reports aligned to operational and compliance needs. Over time, the platform expanded with additional capabilities and advanced modules, such as a Quality Attestation module and SmartVisit functionality, deepening visibility and strengthening collaboration with provider groups.

This unified framework improved data transparency, enhanced provider alignment, and enabled more consistent oversight across medical management teams.

Impact – At a Glance

• 29 reports launched at implementation
• 20,000 members managed on the platform
• 60+ provider groups statewide actively using the solution
• 2 years of sustained performance gains

This solution was delivered in partnership with DataLink.