A prominent healthcare IT company based in the United States and Puerto Rico, boasting a network of over 1,200 providers and serving 600,000 members, faced the challenge of integrating disparate data sources to extract actionable insights about their patients.
With a focus on enhancing patient care quality and boosting reporting accuracy, the company sought to consolidate information from five different sources including electronic health records (EHRs), laboratory data, and claims. However, the lack of visibility into their network and fragmented clinical data hindered their efforts to gain a comprehensive understanding of patient health.
To address these issues, the organization turned to Hexplora’s Data Activation platform, which effectively unified out-of-network evidence, clinical records, and claims data. By leveraging Hexplora’s analytics solution, InGraph, the company’s network providers could identify high-utilization services and cost drivers, while accurate risk stratification enabled timely interventions for at-risk patients. Furthermore, with InCare, Hexplora’s AI-assisted care management solution, personalized patient care and targeted interventions became possible, revealing gaps in care delivery.
The adoption of data-driven strategies yielded significant outcomes for the organization, including the flagging of over 600,000 care gaps at the point of care and the creation of customized care plans. Moreover, STAR Ratings improved, contributing to a 6% reduction in emergency department utilization rates and a 5% increase in benchmarks with clinical documentation improvement. The company also capitalized on cost-saving opportunities to enhance revenue streams and successfully plugged care gaps within the first three months, resulting in improved STAR Ratings.
Hexplora, recognized as a leading Health Cloud company, is committed to driving innovation in healthcare. Their Health Cloud platform facilitates the aggregation of patient data across various systems and care settings, empowering healthcare organizations to develop scalable applications that enhance clinical, financial, and operational outcomes.
With deployments in over 600 care settings across the U.S., Hexplora has enabled more than 96,000 providers to transform care delivery and collaborate effectively with payers and life sciences companies. Their solutions have unified health records for millions of individuals, generating substantial cost savings exceeding $40 million.
