Swift and Scalable Data Solutions

Monolithic IT legacy systems in place have been stretched beyond their limits. This calls for a total overhaul and replacement from these legacy systems to custom systems that are flexible, has a good level of interoperability and user-friendly features.

More people are in need of care and the numbers are growing by the minute. This is where the state health and human resource agencies require the best in suite technology solutions to meet the demands of dynamic and growing population.

State Medicaid agencies must properly appropriate tax payers’ dollars they spend for healthcare, whether those dollars are spent on fee-for-service claims, managed care plans, or through new and evolving value-based payment programs.

Yetira helps state utilize Medicaid funds to ensure fiscal integrity, prevent fraud, waste, abuse and comply with CMS regulations

A growing number of states have established databases that collect health insurance claims information from all health care payers into a statewide information repository. A handful of states had enacted “all-payer claims databases” (APCDs) and many are operational. They are designed to inform cost containment and quality improvement efforts. Payers include private health insurers, Medicaid, children’s health insurance and state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans, and Medicare (where it is available to a state).

The APCD databases contain eligibility and claims data (medical, pharmacy, and dental) and are used to report cost, use, and quality information. The data consist of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics. To mask the identity of patients and ensure privacy, states usually encrypt, aggregate, and suppress patient identifiers.

The number of people requiring healthcare is rapidly increasing with the increase in population and lifespan. This poses a challenge to today’s treatment delivery method as patients’ data increases. With this, large integrated hospitals incur operating expenses of between $200 million and $700 million annually to embrace value-based payment programs that require an interoperable IT ecosystem that consists of an integrated electronic medical record (EMR), a payer-agnostic revenue cycle management platform, and a cross-functional supply chain management solution.

Yetira’s healthcare data analytics solutions collect data from these underlying sources and normalize evidence at the patient, provider, and payer levels. The analytics allow healthcare end-users to identify gaps in care early and to intervene with evidence that quantifies how to save money, increase revenue, and improve outcomes.