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  • Payers

    Insurance Companies, Health Care Payers and Government Agencies

    Automated Medical Decision Making

    Usage of automated medical decision-making is growing rapidly. Medical analytics facilitate efficient management of a wide range of health conditions. Accurate data combined with predictive analytics gives healthcare payers tools to make comparisons, thus improving care and reducing unnecessary costs.

    Medical calculators arm payer organizations with the tools they need to:

    ● Support clinical insights

    ● Attain more accurate reimbursements

    ● Improve pre-authorizations

    ● Reduce hospital re-admissions and unnecessary visits to emergency departments

    ● Eliminate ineffective use of resources

    Medical Calculators Improve Cost Economics

    Use of medical calculators will increase as electronic medical record (EMR) data becomes more integrated. Collecting and analyzing data systematically can provide payers with comparison models to develop meaningful measures of healthcare value. With such knowledge, payers can incentivize providers to improve patient care at lower overall costs.

    Insurance companies can get verification of medical issues by using medical calculators. There are thousands of analytics in medicine, and many are immensely useful to check on rare conditions and review potentially expensive treatment plans. With a medical calculator, payers can easily get an independent verification from scientific, evidence-based professional analytics.

    Sample Calculators

    Incorporating medical calculators into the reimbursement process can give payers powerful evaluation capabilities to simulate a clinician’s decision making process. These tools will help payers effectively contain costs while still assuring quality care. Below are a few samples of medical calculators that will arm payers with this valuable medical knowledge.

    ● Reynolds Risk Score for Cardiovascular Disease in Women

    ● Type 2 Diabetes Risk (Framingham Offspring Study)

    ● Comprehensive Geriatric Assessment Tool (HOPE)

    ● Criteria for a Potentially Avoidable Hospital Readmission

    ● Allergic Rhinitis Severity Score

    ● Criteria for Performing CT Scan in Child After Head Trauma

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