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Population Health Module

Population health analytics and management platform supporting HEDIS quality measures, risk stratification, predictive analytics, SDOH screening, and CMS Stars ratings.

10
Pages
5
API Endpoints
6
High-Priority Orgs
5
Requirements

Organization Relevance

ACO: High MCO: High Health Plan: High FQHC: High IPA: High PHO: High TPA: Low MSO: Low

How It Works

The population health module aggregates clinical, claims, and social determinant data to stratify populations by risk level. HEDIS measures are calculated to track quality performance. Predictive models identify members at risk for adverse outcomes. Interventions are targeted to close care gaps. The Stars module tracks CMS Star Ratings performance for Medicare Advantage plans.

Requirements

  • HEDIS-certified measure engine
  • Risk stratification algorithm
  • Predictive analytics modeling
  • SDOH data collection tools
  • Disease registry capability

Target Audience

Population Health Teams, Quality Directors, Medical Directors, Data Scientists, Care Managers

Pages (10)

PagePurposeKey Features
Population Health Dashboard Population-level health metrics and performance overview Population metrics, Risk distribution, Quality scores, Trend analysis
HEDIS Measures HEDIS quality measure tracking and performance improvement Measure rates, Gap analysis, Provider comparison, Improvement tracking
Interventions Targeted health interventions for identified care gaps and at-risk populations Intervention catalog, Target population, Outcome tracking, ROI analysis
Pharmacy Management Population-level pharmacy analytics and formulary optimization Pharmacy trends, Formulary analysis, Cost optimization, Adherence programs
Predictive Analytics Predictive modeling for adverse events, hospitalizations, and cost Risk prediction, Model performance, Actionable alerts, Cohort analysis
Disease Registry Condition-specific disease registries for population tracking Registry management, Condition tracking, Outcome monitoring, Reporting
Risk Adjustment HCC risk adjustment coding and RAF score management HCC coding, RAF scores, Coding accuracy, Revenue impact
Risk Stratification Population risk stratification using clinical and claims data Risk scoring, Stratification tiers, Factor analysis, Population segments
Social Determinants Social determinants of health screening, tracking, and resource referral SDOH screening, Resource directory, Referral tracking, Impact analysis
CMS Stars Ratings CMS Star Ratings performance tracking and improvement for MA plans Stars dashboard, Measure tracking, Improvement plans, Bonus projections

API Integrations

  • HEDIS data submission API
  • CMS Stars data API
  • Risk adjustment API (HCC)
  • FHIR SDOH APIs (Gravity Project)
  • Predictive model scoring API

Referenced Resources

  • NCQA HEDIS Specifications
  • CMS Stars Technical Notes
  • HCC Risk Adjustment Model
  • Gravity Project SDOH Standards

Expected Results

Improved quality scores, proactive risk management, targeted interventions, and better health outcomes across member populations.