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 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.
Optimize the network of providers within a plan, ensuring adequate service levels, quality and plan financial performance
Ensure delivery and customer support resources are staffed appropriately to meet contractual obligations while minimizing overall cost
Determine the optimal points for infusion drug delivery, considering demand, location, service level requirements, contractual relationships with providers and overall cost minimization objectives
Quantify the cost to serve different customers before signing them to properly structure pricing and contractual penalties
Increase confidence in provider partnerships to deliver under capitated care models by establishing the right mix of outreach and population management programs
Design the optimal mix of plan benefits that meet customer requirements while ensuring financial viability of the plan
“Intelligent Modeling has an ability to bring stakeholders from all over a business to discuss and agree on how their business should be modeled...Because operational activities can be mapped to financial implications, River Logic's Intelligent Modeling allows our clients to embark on a journey to generate solutions to problems that have a global optima.”