Frequently Asked Questions (FAQ)

On March 22, 2019, Clinigence, LLC and QualMetrix Inc. merged to become Clinigence Health. We are very excited to join forces, and here are answers to frequently asked questions about the merger. Welcome to Clinigence Health.

Why did Clinigence and QualMetrix merge to become Clinigence Health?

We came together to enable healthcare organizations to realize the full potential of population health initiatives and value-based care models, and ultimately to support the improvement of patient outcomes with the most cost-effective care. 

What does Clinigence Health do?

In healthcare today, successful outcomes are measured by two sets of data: cost and quality. Clinigence Health brings together both cost and quality data in one unified platform so our customers can make better data-driven decisions to achieve better health outcomes at lower total cost.

What data challenges does Clinigence Health address? 

Value-based care is critically dependent on data. Valuable data exists in multiple, disparate systems, and its potential is often lost due to the difficulty for organizations to integrate all data types and sources necessary to innovate and optimize performance. Clinigence Health aggregates and normalizes our client’s multi-source data into our unified cloud-based platform, transforming it into readily available, actionable intelligence that supports critical clinical and financial decisions.

What has changed following the merger? 

Clinigence Health combines Clinigence’s wealth of clinical quality reporting and outcomes improvement tools with QualMetrix’s powerful cost and utilization analytics to provide our customers with a comprehensive view of healthcare cost and quality for population health and value-based care. Whether you are currently looking for clinical quality reporting or total cost-of-care management solutions, Clinigence Health ensures that you will have everything you need to succeed from a single vendor and a unified technology platform.

Who does Clinigence Health serve?

At Clinigence Health, we enable payers, providers, and other healthcare and life sciences organizations to improve clinical and financial performance, assess, predict and mitigate risk, and to improve the quality and cost outcomes of care.

We are dedicated to providing the best and most advanced healthcare analytic tools for all of our customers, and currently we help 15 ACOs, 9 health plans, 2 MSOs, 23 hospitals, and 8,000+ providers optimize the quality and cost of care for 9 million lives.

What is the value Clinigence Health provides?

Clinigence Health can help you leverage intelligence-based, results-driven insights from claims and clinical data, so you can deliver high-quality care — efficiently and effectively.

One Partner. One Platform.

  • Analyze both clinical and financial population data with a multi-stakeholder approach that presents clinical quality alongside total cost.
  • Quickly achieve value through a robust healthcare analytics platform that includes more than 60 pre-built dashboards and reports, implemented in a matter of weeks.
  • Optimize healthcare cost and quality in one place — no more multiple logins across several different applications.
  • Leverage integrated data from multiple sources, across settings and systems, to operate efficiently and to deliver the best possible outcomes for patients. 

Accelerate Value-Based Care and Population Health Management.

  • Use big data to reduce waste, clinical variation, and unnecessary costs.
  • Improve organizational behavior and compliance to remain competitive amid evolving reimbursement models, regulatory mandates, and industry changes.
  • Strengthen payer-provider relationships with data transparency on a shared, integrated platform.
  • Optimize provider networks to reduce unwarranted variations in care, prevent referral and network leakage, and improve overall provider performance.
  • Uncover opportunities to improve cost and care across your entire organization by identifying patterns in population data and taking action to maximize performance. 

View the Big Picture… See the Details Necessary to Act.

  • Our analytic tools are designed for fast and intuitive identification of financial and care improvement opportunities at the top organization/population level, and the ability to easily drill down to the individual provider and patient levels where you can take the most effective improvement actions. 
  • Uncover deviations in quality of care, provider performance against peers, and care patterns to facilitate improvement.
  • Identify opportunities and outliers, and measure performance over time to reach desired goals.
  • Explore deeper levels of detail to identify the root causes and the most effective interventions to improve outcomes. 
  • Translate complex, disparate data into simple, consistent actions.
  • Evaluate cost and quality performance holistically, including against payer contracts, provider networks, populations, and more. 
  • Identify opportunities for cost savings and quality of care improvements down to the individual provider or patient level.

Leverage Predictive Analytics to Reduce Clinical and Financial Risk. 

  • Using past and real-time data, Clinigence Health applies predictive analytics to provider groups and patient populations to forecast cost and quality risks – turning risk into opportunity.
  • Predictive analytics are particularly valuable in identifying opportunities to intervene, minimizing spend on patients with higher risks of emergency room visits, hospital admissions, chronic care complications, or other adverse events. 
  • Understand concurrent and prospective cost and utilization risk and identify opportunities to enhance the management of your patients, which is crucial for all organizations involved in healthcare.
  • Mitigate risk confidently with the most comprehensive set of data provided by both clinical and claims records combined with industry-leading risk models.
  • Gain efficiencies and cost savings through insights into patterns and trends that impact quality and overall cost healthcare.

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