Opportunity Framework - Certilytics Opportunity Framework - Certilytics

Maximize the Value of Every Healthcare Dollar

How much more value would you get from your data if your clinical, actuarial, and business teams were aligned on the best strategies to improve health and reap financial savings?

The Opportunity Framework attaches a financial value to the mitigation of negative health outcomes through Gap in Care (GIC) closure, earlier interventions for those with emerging chronic conditions, and the avoidance of high-cost events such as ER visits.

Better Alignment to Drive Better Outcomes

Our customers use this framework to make data-driven decisions and energize their total health management strategies to maximize the value of every healthcare dollar. This is achieved by aligning clinical and financial stakeholders in the design of new programs, the allocation of clinical resources and treatment decisions, and the development of novel, risk-based pricing and reimbursement strategies.

Our customers have used the Opportunity Framework to achieve millions of dollars in financial savings while driving significant improvements in health and utilization, including a shift from in-patient admission to preventive outpatient care and increased medication adherence.

Ready to learn more? Schedule a meeting with our team of experts—today.

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Case Study

One national insurer optimized its care management programs with the Certilytics Opportunity Framework, leading to millions in year-over-year savings. Moving from retrospective to prospective reporting, the insurer did a better job identifying members not only with the greatest financial exposure but with the highest likelihood of changing their behaviors in response to clinical outreach. This resulted in a shift away from inpatient hospital admissions toward preventive services such as outpatient PCP visits.

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