Healthcare Payers

In today’s ever-changing payer market, having a holistic view of your business is more important than ever.

Prescriptive Planning & Performance Management for Healthcare Payers

Payers are constantly facing challenges, from keeping their tax payers / shareholders and clients healthy to ensuring the right access and level of care, all while managing costs. Increasingly, healthcare payers must improve their ability to meet complex objectives by finding the optimal balance of care, access to drugs, cost of care, etc. Furthermore, they are expected to bring fresh ideas and innovations that drive partnerships with providers.

Our prescriptive planning platform allows payers to simulate and optimize decisions against a set of objectives that can include access to care, quality of care and financial performance. Furthermore, it allows managers to track their performance against these objectives, all the way down to the key drivers to facilitate change.

Our Solution

Our prescriptive planning and performance management platform allows healthcare payers to represent their business realities quickly while easily defining and exploring alternative scenarios. Payers who adopt River Logic achieve significant cost reduction without sacrificing quality and access to care, all while appropriately balancing risk.

Features

Provider network

Optimize the network of providers within a plan, ensuring adequate service levels, quality and plan financial performance

Delivery

Ensure delivery and customer support resources are staffed appropriately to meet contractual obligations while minimizing overall cost

Drug formulary

Determine the optimal points for infusion drug delivery, considering demand, location, service level requirements, contractual relationships with providers and overall cost minimization objectives

Cost to serve & pricing

Quantify the cost to serve different customers before signing them to properly structure pricing and contractual penalties

Accountable care

Increase confidence in provider partnerships to deliver under capitated care models by establishing the right mix of outreach and population management programs

Plan benefit design

Design the optimal mix of plan benefits that meet customer requirements while ensuring financial viability of the plan

How is River Logic Different?

River Logic creates a single, end-to-end model of a business or enterprise. With the power of prescriptive analytics and the ability to run unlimited what-ifs, companies are able to
find undiscovered opportunity values and optimize decision making.

River logic Prescriptive-based Optimization brings unmatched value

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