Core Services

We are committed to serving clients in all sectors of the health care industry. We provide health outcome research and evaluation services; data analysis and other software services; regulatory and policy-related services; and auditing, compliance, and contract review services. Strong relationships are maintained in government, academic, and private sectors of health care to facilitate our client goals.

Analytical Services

Our uniquely available intelligent analytical model is applied to claims data using sophisticated proprietary algorithms that identify uncoordinated care and quantify cost savings related to that uncoordinated care. Based on this, we can uniquely identify, quantify cost savings and target patients exhibiting uncoordinated care patterns for care/disease management intervention programs and medical homes to achieve cost savings and improved outcomes. 

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Care and Utilization Management Services

Our personnel have extensive experience in providing consulting, data analysis and clinical services for utilization review/case management in both Medicaid and commercial fee for service and managed care programs. We provide the services of licensed pharmacists and professional staff with extensive experience in clinical and economic evaluations to meet the requirements of the contract. We also provide evaluation and assessment regarding the quality of care participants receive as a result of drug therapies based on treatment guidelines and best practices and other clinical intervention and educational support provided for enhancing clinical outcomes.

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Regulatory and Policy-Related Services

Our regulatory and policy-related services include, but are not limited to reviewing and designing health plan fraud policies, programs, and claims edits, consulting on health care reform policies and inititiatives at the state and federal level, health information technology and policy, pharmaceutical benefit analysis and design, and formulary/PDL program and policy evaluation. 

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Auditing, Compliance, and Contract Services

We offer support in the areas of medical and pharmacy claims auditing, pharmacy purchase, inventory, and billing reconciliation audits, developing internal audit procedures and quality assurance measures, and third party claims auditing and compliance reviews. 

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