Health Plans

Say yes to fast, flexible analytics and reporting with enriched whole health views.

Say yes to deeper insights with way less work.

How does HDMS help Health Plans and TPA’s?

Connected Health Insights

Health is connected, but data can be another story. Get whole health insights with integrated data from across your enterprise and your partners.

  • Build more value using enriched enterprise data
  • Bring in partner and point solution data
  • Present integrated reports to your customers
  • Fuel internal innovation and strategy

Do more with less.

Enriched and connected data, ready for all your analytic teams.

Reports and ad-hoc

Visualize data for customers

Self service analytics

Empower internal teams

Dashboards and Alerts

Simplify insights for busy executives

Analytic Pathways

Surface connected insights to analysts

It’s all about the data

Analytics are easy when data is prepared in the right ways.

Robust classifications

Member 360

Predictive models

Data preparation classifies and structures data, including 40+ industry methodologies.

Data prep and data engineering makes all the difference in analytic environments.  Applying industry standard and industry-leading methodologies within your health data platforms lets you ask questions like  How do social determinants of health influence PCP-appropriate ER visits?   with just one click.

HDMS offers 25+ social and environmental indices and dimensions, which enrich anlytics.  Explore SDoH – just one of the HDMS enriching methodologies, and how this expands and deepens health plan insights.

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Connect views at the member-level using sources within and outside your organization.

Top-shelf member-centric data fabric fed directly or through an enterprise data warehouse (EDW).

Bring together multi-source in-house information along with third party and supplemental data.  Understand people from all health perspectives.  Your Member 360 is the foundation of holistic health insights for your organization.

Artificial intelligence and machine learning is at work for you.

HDMS offers sophisticated  yet highly usable predictive analytics.

  • Native models built and trained using extremely large data assets (improves prediction intelligence)
  • Robust approach includes detailed outputs, stored historical predictions, and multi-model analytic views
  • Usability enrichments include categorizations and segments (e.g., high, medium, or low risk)
  • Dashboards for each model plus analytics with multiple model intersections

Predictive models for what?  Let’s build and use them where we can make an impact – that’s our philosophy.

We offer predictive models to address areas like:

  • ER visits
  • Admissions
  • Costs
  • Leave

Interact with predictions and member-level outputs for activation strategies. 



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Empowering Analytics

With all this data, insights are deeper.  Actions are impactful.

Program Evaluation

What is the value and health impact of this point solution? How does this partner solution influence total health costs?

Population Health

How can we design new programs that reduce barriers introduced by social determinants of health?

Plan Performance

Where can we influence plan design for increased engagement and reduced out of pocket expenses?

Provider and network analysis

How do our providers perform and where can we optimize our network for our trending needs?

Financial Reporting

What is driving the trends we see? What actions should we prioritize to manage costs in the next few quarters?

Plan Sponsor Reporting

How do we measure the value we deliver to our broad customer base? How do we simplify required reporting?

So what are the key benefits?

Better products and programs

You design with detailed knowledge. Easily understand how to increase affordability, convenience, engagement, and address equity barriers.

Optimized plan performance

You guide plan sponsors to achieve higher value and they stay with you. Your analytics allow strategic recommendations with measured results.

Predictive and proactive culture

You create transparency into trends and emerging risks. Forward-thinking solutions better serve communities and members.

Increased operational efficiencies

You complete administrative reporting fast and effectively, with more interesting and enriched analytic content. More time for innovation!

Health plan data analytics for a wide variety of markets

What analytics are key for Commercial Plans?

Commercial plans clients are smart and attentive to details. Key analytics include comprehensive dashboards with drivers of trend, sophisticated population health with social determinants of health (SDoH)  integrated to understand health equity, network management, provider quality, and analytics that help you demonostrate your unique value.  You will want to tailor analytic content to highlight the value you have delivered as well as quantify opportunities for improvement in areas where you offer additional options, to help design plan refinements to drive improvements year over year.

What analytics are key for Medicare and Medicaid Plans?

Medicare and Medicaid plans have members that often require an increased amount of care.  It is critical that these plans have deep and detailed knowledge about the level of quality and cost.  Sophisticated data analytics illuminate beneficial cost savings and quality improvement initiatives with enriched data that allows for deeper investigation into social determinants of health and predictive analytics. These insights reveal barriers to care, low value care, and are the foundation for future innovation.

What are key analytic considerations for Regional and Managed Care Organizations?

Regional plans and MCOs measure and manage risk for years. This enables the ability to identify the highest risk populations for more focused and effective cost and quality management programs.  In addition to having data lifecycle management flexibility, analytic environments must be flexible, adaptable, and incorporate social determinants of health to design into long-term studies with cohorts.

Data is a pain.

Technology keeps changing. Partnerships change.
Questions are different.

With HDMS you have a flexible platform and people to work it so you can look forward – everyday.


Be a power user or give us your task list. Or both.
We’re ready for you.

See how this client quickly adapts to change

Analyze what?

High-Cost Claimants

Set your own thresholds

Quality of Care

PQI, Gaps, HAC

Treatment Variation

Low value, Overuse, Supply Sensitive


Specialty Rx, Outpatient, Opiods

Population Health

Social Determinants of Health

Chronic and Impactable Conditions

Fertility and Maternity

Total Cost of Care


Cohort comparisons

Variance from Reference-based Pricing


Optimization, Provider attribution, Care quality


HDMS produced a pandemic cost model

ER, Inpatient, Outpatient

Evaluate trends, cost drivers

Configurable analytics

In addition to the robust out-of-the-box library of analytics and reports, build your own in a simple design environment.