Analytic Enhancement Tools
MODELS THAT SIMPLIFY AND ACCELERATE VISIBILITY INTO QUALITY AND COST DIMENSIONS
Better methodologies promote better healthcare decisions
Blue Health Intelligence’s (BHI) proprietary methodologies help payers, providers, and other healthcare stakeholders make more accurate business decisions and isolate root causes for overutilization and other quality and cost issues. Backed by decades of experience in delivering complex analytic solutions, our proven methods for analyzing healthcare data leverage the latest technology and clinical understanding to more quickly deliver actionable results and recommendations.
By applying these methodologies to BHI’s robust data, we offer transparent, in-depth, and detailed analytics that allow decision makers to more accurately close care gaps, optimize provider networks for lower-cost / higher-quality care, reveal opportunities for care interventions, execute value-based arrangements, and identify at-risk patient populations.
In addition to being embedded in our products and services, BHI’s proprietary methodologies are available as stand-alone algorithms that can be licensed by organizations requiring analytic rigor that facilitates better communication through a shared understanding of causes and results.
BHI's analytic enhancement tools were built by a team of leading health plan experts, clinicians, statisticians, data scientists, expert coders, information technology professionals, and actuaries.
As interest grows in defining episodes that extend beyond a member’s discharge from the hospital – or apart from hospitalizations altogether (e.g., disease-based episodes) – episode groupers play an increasingly important role. Payers need the ability to reliably predict the costs to treat certain types of patients and pay accordingly. At the same time, providers require the means to assess their own costs relative to the episode payments to identify opportunities for improvement.
EPISODE OF CARE GROUPER (EoC)Clinically accurate comprehensive comparisons
The BHI Episode of Care (EoC) Grouper bundles care for thousands of conditions and complex treatments into a single unit of analysis. Our grouper leverages extensive data to analyze over 1,500 conditions and procedures, producing clinically accurate and comprehensive comparisons. Its unique integration of medical and pharmacy claims data with clinical logic empowers healthcare stakeholders to make more informed contracting decisions, conduct research, and better understand the cost and quality of care offerings in different settings.
BHI’s CarePulse rules engine replicates and shows progress towards achieving industry-recognized quality measures, including HEDIS metrics, NCQA, AHRQ quality measures, prescription fill rates, and more. CarePulse can also reproduce any custom measures your organization has developed, such as provider attribution logic, to help achieve healthcare’s Triple Aim. Our fully transparent view of quality-related measurements helps organizations find gaps in care, identify provider improvement opportunities, and/or assess how partners are faring under risk-based arrangements.
HEALTHCARE BARRIER INDEXCONTEXTUAL UNDERSTANDING FOR BETTER HEALTH OUTCOMES
The BHI Healthcare Barrier Index weighs claims data and social determinants of health (SDoH) factors to determine the level of difficulty any individual or population will encounter when seeking care. Stakeholders in turn use BHI’s Healthcare Barrier Index to identify interventions and supports that have the highest likelihood of successfully helping individuals get the healthcare services they need. Since 40% of overall health is impacted by SDoH, knowing what non-medical factors need to be addressed – and when – is key to ensuring the success of any care management efforts.