Best Utilization Management Software

Distilling fractured health data into actionable insights. Clarify Health’s analytics platform cuts through the fog. We help you thrive in a post-pandemic world by delivering precise insights into provider performance, patient journeys, and therapy adoption. Leverage our advanced analytics software to confidently improve physician performance, match patients to the right care, and navigate value-based arrangements. Access insights to accelerate product launch and growth, demonstrate real-world impact, and enable outcomes-based commercial agreements. Identify top physicians and facilities more accurately, deliver a more personalized experience to members, and maximize value-based engagements. Timely insights through thousands of predictive models that organize data into real-time analyses to drive demonstrable ROI. Driven by big data. Powered by innovative technology. Turning health data into impact.

Coordinating care, evaluating and demonstrating quality, identifying risks, and monitoring compliance all require data from multiple sources and systems — and all are key to improving the patient and provider experience. ​ ​Midas Health Analytics improves operational and clinical performance with solutions that manage risk, control cost, and turn data into actionable insights.​ Track and trend performance over time, proactively manage and mitigate risk, make data-driven decisions amid constant regulatory changes, and elevate and foster a safe care environment for all. ​ ​Reach unprecedented operational efficiency when evaluating, interpreting, and demonstrating quality of care performance results to stakeholders in today's complex healthcare ecosystem.

Improve organizational performance and validate OASIS data more efficiently with cloud-based quality reporting and analytics software for home health. Empowering home health agencies to identify actionable opportunities to improve outcomes and star ratings, reduce readmissions, boost referrals, and increase revenue. OASIS Intelligence is the go-to resource for your home health agency’s performance improvement needs. From organizational performance analysis to accurate and rapid validation of OASIS data, our cloud-based application has you covered. Access the most current data available to identify performance trends and gaps, drive faster process improvements, and increase star ratings. Ensure quality and proper reimbursement with automated alerts that help you stay on top of errors and inaccuracies on the OASIS form. View everything from monthly trends and condition-specific analyses to patient-level results with our comprehensive and flexible reporting.

A new category of utilization management software, CORTEX provides a 360° approach to addressing the intricacies of utilization management and revenue cycle processes. Powered by real-time predictive analytics and machine learning engine, CORTEX ensures that the right cases are handled at the right time, by the right staff or by exception. CORTEX incorporates precision medicine upon a foundation of evidence-based medicine. Machine learning models operate in real-time to better assess your patient population. Our analytics have been deployed in hospitals and health plans across the nation. With clear inpatient cases, CORTEX does the heavy lifting by automating inpatient determinations on cases that meet your unique threshold. For difficult cases, CORTEX offers your staff the insight they need to make a strong determination. This approach offers incredible value to payers and providers alike.

Unleashing the power of Medius’ multi-cloud artificial intelligence platform to deliver greater than 90% accuracy and coverage on various health intelligence and risk predictions using just a few health variables. Using just a few health data co-ordinates, Medius’ multi-cloud artificial intelligence platform aggregates, and mines massive datasets to create all relevant health risk and underwriting insights within seconds, with over 90% accuracy and coverage that can help providers and payers with their health and life needs assessments, distribution, operations efficiency, and cost optimization needs. Medius’ proprietary UW Studio™ is a complete underwriting platform delivering the AI revolution that has fundamentally altered the insurance landscape whereby multiple science-based underwriting ensemble models are deployed to address the business and technical requirements by reproducing humanistic deductive actuarial reasoning with clinical accuracy.

Lightbeam provides population health enablement by transforming insights into outcomes. Closing care gaps and minimizing risks. Improving quality of care and quality of life. Lightbeam’s proven population health management platform transforms disparate data into a full 360-degree patient picture, bringing true value to value-based care. In today’s value-based care model, managing risk begins and ends with data intelligence. Lightbeam’s powerful population health management platform pulls patient data together in unprecedented ways, unlocking the value that comes from deploying the right data in the right place at the right time. Lightbeam isn’t just revolutionizing how our clients manage value-based care. It’s proving to be a game changer in driving results and saving our clients over 2 billion dollars since 2014 and we’re just getting started. Lightbeam’s tech-enabled services approach seamlessly supports these efforts.

Personify Health is the first personalized health platform company, offering integrated solutions that combine health, wellbeing, and navigation services. Formed through the merger of Virgin Pulse and HealthComp in November 2023, Personify Health aims to simplify healthcare by providing personalized, connected, and user-friendly experiences. Their comprehensive platform includes services such as health plan administration, holistic wellbeing programs, and care navigation, all designed to empower individuals to engage more deeply with their health. By leveraging data-driven personalization and science-backed methodologies, Personify Health helps businesses optimize their healthcare investments while improving health outcomes for their members.

There are patients who desperately need your home health services — yet many physicians who could be referring them aren’t. That’s likely because your sales and marketing teams aren’t seeing the 75% of Medicare claims associated with office visits. Demonstrate your ability to lower costs and improve patient outcomes. Home Health Agency A can quickly demonstrate how it outperforms Home Health Agency B on hospitalization and readmission rates. Marketscape for Home Health helps you redefine your sales and marketing strategy to ensure you’re focusing on high-potential physician and facility referral sources. Our breakthrough technology and support help you: Quickly evaluate how you compare to your peers by hospital and readmission rates, diagnostic category, acuity level, time to start of care, total cost of care, and many other quality metrics.

Our industry-leading, artificial intelligence (AI)–driven technology converts both structured and unstructured healthcare data into a high-quality, reliable, standardized dataset that can be used across your organization. Accessing data in near real-time from disparate systems, our products and services reduce the burden of manual data abstraction so your administrative and clinical teams can recapture that time for quality and research initiatives. Our products and services allow you to collect, analyze, and act on your data, regardless of data source, therapeutic area, organizational department, or existing reporting, BI, or analytics tools. Atlas uses human expertise and the power of AI to automate and simplify the resource-consuming task of finding and interpreting patient data for clinical registries. Cartographer searches, analyzes, and interprets patient data across all platforms, standardizes those data into a consistent format, and provides relevant data recommendations.

TAGNOS empowers healthcare workers to provide an elevated level of patient care. Perform more surgeries safely and efficiently by improving on-time starts, accelerating room turnover, increasing scheduling capacity, implementing real time situational awareness, and more. Treat and satisfy more patients with structure and accountability by decreasing left without being seen (LWBS) rates, accelerating time to treatment, streamlining intra- & inter-departmental communications, and more. Deliver improved asset utilization and reduce supply waste, eliminate search times, streamline work orders, optimize par levels, and more. TAGNOS OR Orchestration safely and efficiently empowers healthcare professionals to perform more surgeries by providing real time situational awareness and data-driven performance insights. OR Orchestration improves on-time starts by accelerating room turnover and optimizing schedule utilization for a better patient experience.