In a typical health care model, there is an insurance company (“payer”) in between a hospital (“provider”) and an employer (“sponsor”). The payer is a healthcare organization that pays claims and administers insurance or benefit product. The sponsor buys the health benefit product from the payer for its employees. That means the employees become members and eligible to go to hospital when they need care. The providers are paid by the payer for the service provided to their members.
Plan Analytics and Reporting Provider Profiling and Reporting Incentive Management HEDIS Reporting 360 Degree View of Members
Care Management Predictive Modeling and Analytics Data Warehousing Population Health Management Patient Generated Health Data