MedeAnalytics Value-Based Care Insights with AI-Enabled Next Best Action

Incentivize partnership in care delivery and outcome improvement.

MedeAnalytics accelerates VBC transformation through a unified, AI-powered platform that aligns payers, providers, and community supports to drive measurable improvements in cost, quality, and equity. With actionable insights and advanced analytics, MedeAnalytics empowers healthcare stakeholders to:

• Strengthen provider networks

• Measure performance on quality and cost

• Align reimbursement with at-risk and shared savings models

Powered by our foundational AI-enabled Health Fabric™, clinical and claims data are integrated into a single platform, offering a 360-degree view of patient health through Integrated Analytics. Embedded generative and agentic AI with guided action enhances workflows; enabling more collaborative, timely, and proactive care.

This data-driven approach helps organizations mitigate risk, drive performance and accountability, elevate patient outcomes, and operationalize VBC programs by:

• Identifying high-risk and rising-risk patients to target interventions and reduce costs

• Enhancing visibility into provider performance with peer comparisons, cost patterns, and utilization trends

• Evaluating cost and quality metrics to support shared savings and value-based payment models

• Facilitating care coordination through seamless integration with care management platforms

• Ensuring network adequacy and high-quality provider performance

• Enabling AI-assisted action plans that deliver measurable ROI and improved outcomes

Accelerate value-based care transformation

MedeAnalytics drives execution through its Managed Action™ framework, combining AI-assisted action plans with embedded workflow insights. Paired with Strategic Advisory Services, organizations gain expert guidance to translate performance improvement opportunities into measurable value, reducing costs and enriching care by turning insights into action.

Data-driven use cases in value-based care

The MedeAnalytics healthcare performance platform helps organizations address critical challenges through:

Risk Management & Predictive Modeling: Maximize reimbursement and reduce costs through advanced risk adjustment and forecasting.

• Detect HCC gaps, validate documentation, and assess RAF impact to reduce inefficiencies and compliance risk

• Identify which high-cost utilizers have the highest propensity to impact through interventions

Provider Network Management: Build and maintain high-performing networks to ensure adequacy and minimize revenue loss.

• Analyze claims data to detect network leakage and retention opportunities

• Compare providers on a level playing field using machine learning that eliminates factors outside of their control such as social factors and case-mix

Quality & Performance Measurement: Enable shared accountability and continuous improvement with reliable performance metrics.

• Measure and benchmark HEDIS and quality scores and submit scores directly to NCQA to enable a single source of truth for provider performance calculations

• Power clinical quality measure performance using HEDIS Electronic Clinical Data Systems (ECDS) reporting to provide a richer perspective on clinical data

Actionize Outcomes: Drive value-based action on insights through AI, automation, and workflow enablement.

• Leverage playbooks (or build custom ones with AI) to guide actions and execute on VBC strategy

• Push aggregated VBC insights into critical parts of the patient workflow, such as at point-of-care, care management, and patient engagement, to drive maximum impact