Analytic Tools

Methodologies that simplify and accelerate visibility into healthcare quality and costs.

Better analytic tools empower better healthcare decisions

Our analytic tools help payers, providers, and other healthcare stakeholders make accurate business decisions and isolate root causes of quality and cost issues. Backed by decades of experience in delivering complex analytic solutions, our proven methods for grouping, analyzing, and sharing healthcare data leverage the latest technology and clinical understanding to deliver actionable results and recommendations.

By applying these proprietary methodologies to their data, decision-makers can accurately close care gaps, optimize provider networks for lower-cost and higher-quality care, reveal opportunities for care interventions, execute value-based arrangements, and identify at-risk patient populations. We also apply these same methodologies to BHI’s national data repository to create powerful benchmarks for more informed decision making.

Our analytic methodologies are embedded in our SaaS analytic products and employed in consulting services. They can also be licensed independently.

Analytic tools for transparent and detailed data

BHI's analytic 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.

Health Care Transformation Task Force’s January 2019 report

BHI’s proprietary methodologies leverage a common integration platform to create greater efficiencies and a single source of truth

BHI’s common integration platform links our methodologies and serves as a convenient, single intake point for a vast array of healthcare and non-healthcare data. With one data feed, stakeholders can receive outputs that help them understand:

  • Total cost of care for both medical conditions and treatments
  • Care gaps
  • Risk levels for individuals and groups
  • Provider quality and cost
  • National, regional, industry, and account-level benchmarks

Simple reporting, sharable formats
The metrics and measurements produced by our methodologies can be exported via extract files, batch reports, APIs, or interactive analytic tools. These results can be easily shared with employers, providers, and other vendors. Because our methodologies are transparent, comprehensive, and current, stakeholders can trust our results and rely on them to take impactful cost-saving and quality-enhancing actions.

BHI's Common Integration Platform

Episode of Care Grouper


BHI’s Episode of Care (EoC) Grouper represents the leading edge of commercial groupers, by including both procedures and conditions and a fully transparent methodology. Our EoC Grouper’s clinical logic is presented in an intuitive, easy-to-understand manner, depicting a comprehensive patient history using clinically meaningful units of analysis. Users can view a patient’s condition and entire course of treatment; changes in acuity or stage; and the subsequent symptoms, findings, and complications.

BHI’s EoC Grouper provides the analytic foundation for numerous Blue Cross Blue Shield Association National Programs and can be used to support network assessment, provider scorecards, and value-based contracting arrangements such as bundled payment initiatives.

CarePulse Quality Measurement

Fully transparent, easily integrated

BHI’s CarePulse quality rules engine assesses members’ medical care by applying nationally established and customized clinical rules measures, including preventive, episode-specific, and low-value care measures, amongst others.

CarePulse offers more than 350 measures including those designated by nationally-recognized bodies. CarePulse can reproduce any custom measures your organization has developed, such as specialized maternity or chronic care measures, to help improve quality and lower costs.

Organizations benefit from CarePulse’s fully transparent view of quality-related measurements, which reveal the rationale behind compliance decisions. This helps Plans and employers:

  • Find current and potential future gaps in care, and identify areas of greatest improvement potential
  • Produce patient registries
  • Identify provider quality improvement opportunities
  • Assess how partners are faring under risk-based arrangements.

Designed to measure condition severity

BHI’s concurrent and prospective risk models are derived from the HHS-HCC risk model, which was modeled on DxCG for HHS. The built-in weighting associated with this methodology was designed using BHI’s vast national data repository, which contains more than 20 billion commercial claims.

BHI also offers standalone predictive and prescriptive risk scoring methodologies that combine social determinants of health (SDOH) data with laboratory, pharmacy, and claims information to provide a holistic picture of member risk.


Contextual understanding for better health outcomes

The BHI Healthcare Barrier Index weighs claims data and 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.