Utilization & Financials Analytics

Healthcare Analytics

Caradigm delivers the business and clinical intelligence to generate insights and drive better decisions.


As more healthcare organizations participate in value-based reimbursement models, they have an increased responsibility to report on and improve quality measures. To support population health, your organization needs analytics that deliver retrospective review, ongoing surveillance and predictive modeling.

  •    Retrospective review delivers performance and activity reporting – including patient attribution utilization,    variation in care, and total cost of care
  •    Current or near real-time reporting supports care management, identifying gaps in care and alerting physicians    and patients for care planning from a population view
  •    With risk stratification and predictive modeling, you can classify patients by health risk to deliver cost-effective    interventions and predict and prevent readmissions.


Caradigm offers several analytics solutions designed to identify the insights within the complexity of healthcare. Caradigm’s offerings include solutions that report retrospective activity, monitor current activity and predict future activity, as well as provide the tools for root-cause analysis. Understanding opportunities for financial improvement and how your organization is financially performing are important business insights to help you make the right decisions for managing your population.

Through the aggregation of data to provide cross-organization analysis of care delivery and cost trends, users are able to determine areas for improvement across the continuum of care. With Caradigm Utilization & Financial Analytics you can surface the aggregated clinical and claims data through purpose-built analytic views focusing on utilization patterns across populations, care settings, networks, and payers. Examples of views:

  •    Length of Stay
  •    Admissions per Thousand
  •    Post-acute Care
  •    ED Utilization
  •    Readmissions
  •    Network Steerage (Network Leakage)
  •    Condition Utilization
  •    Drug Utilization

Comprehensive dashboards are provided to enable users to track, analyze, and act on utilization and cost metrics. Built-in drill-down capabilities allow navigation from a population view to cohorts and individual patient records. Steerage reporting identifies where patients receive care beyond the organization, determines root cause drivers for patients exiting network care and highlights opportunities to steer these patients back into the cost containment network. Performance reporting helps identify improvements within certain areas such as ED utilization, readmission, length of stay, and post-acute activities.


How it works



Key Features

  •    Rich underlying data asset, updated in real time
  •    Analytic views of integrated clinical and claims data
  •    Comprehensive and configurable dashboards with multiple dimensions
  •    Per-member-per-month costs across the entire organization
  •    Drill-down navigation from a population view to individual patient to take appropriate action
  •    Performance reporting – ED utilization, readmission, length of stay and post-acute
  •    Patient reporting – condition analysis, medical cost and pharmacy cost


Key Benefits

  •    Combine and normalize information from across the healthcare community
  •    Reveal utilization and cost patterns across populations, care settings, networks, and payers, and take proactive    action on practices that contribute to cost outcomes
  •    Trend, analyze and act on the utilization metrics most important to your organization
  •    Better understand and manage contracts
  •    Identify patients receiving care beyond your organization and steer them back into your cost containment network
  •    Identify proactive opportunities for utilization improvement
  •    Better manage financial risk and high-utilization populations