Empowering Healthcare with Data-Driven Insights
Transforming Data into Actionable Insights for Payers and Providers
At AlignCare Services LLC, we leverage data to drive superior healthcare outcomes, helping you achieve your revenue, quality, and cost objectives.
Our Goal
AlignCare Services LLC is dedicated to empowering healthcare payers and providers with the actionable data they need to exceed their goals. Our mission is to transform complex data into meaningful insights that drive better decision-making and improved patient care.
Our Strategy
Our analytics platform PrescienceRx developed through pioneering collaborations with Johns Hopkins and Wolters Kluwer, delivers cutting-edge solutions driven by pharmacy data.
Our Experience
AlignCare has a very experienced team with deep Payer and Provider knowledge. All the senior management have over 20 years senior experience. Over the years we have worked with both regional and national Payer and Provider clients assisting them from analytics to operational challenges and opportunities.
Impact of AlignCare Solutions
Discover the transformative impact of AlignCare’s innovative solutions on healthcare costs and quality.
New Members
OPPORTUNITY: Neither Payers or providers have data on new members. Historically it takes several months for a Payer or Provider to profile a new member.
Solution
Within days of eligibility PrescienceRx can profile new members and provide:
- Estimated total medical cost next 12 months.
- Estimated adherence/STAR ratings.
- Risk adjustment: HCC suspects.
- SDoH score to determine who might need assistance.
- Members for disease or case management.
Data points which a Payer or Provider network can use to:
- Determine of the top 5% most risky members which ones to focus on.
- Collect data to optimize HCC scores.
- Determine which members to focus on to optimize Star ratings.
- Ensure a smooth transition from the old to new Plan.
- Use for outreach/home visits.
Improve Adherence
OPPORTUNITY: Improve Star rating to achieve a higher a monthly revenue and attract more new members through higher Star ratings. Improved adherence also reduces medical costs. Members with no gaps have 95 acute events per 1000. Members with three gaps have 600.
Solution
PrescienceRx has developed a complete module to address the challenges of Stars for Payers and Providers. The solution covers:
- Identifying members whose adherence is low and potentially why:
- MedSych
- SDoH
- 90 day refill opportunity
- Stratify that population to help the Payer or Provider determine which cases to focus on.
- Calculate adherence on both a rolling 12 months or the CMS calendar year.
- Estimate the impact of improved adherence (ROI)
Inappropriate Prescribing
OPPORTUNITY: It is estimated that health costs related to use of Potentially Inappropriate Medications (PIMs) was $7.2 billion nationally. Adverse drug events (ADEs) were found to be avoidable in 27 percent of cases in primary care.
Solution
PrescienceRx can provide you with the critical information to determine which individuals to focus on:
- Identify all members who have PIM issue
Stratify members with a PIM alert based on factors including:
- Number of drugs they are taking.
- Adherence rates.
- Co-morbidies they have.
- SDoH score.
- Number of PIM alerts.
- Providers associated with these alerts.
Medication Management
OPPORTUNITY: This is the biggest challenge our healthcare system faces. The growth in multiple co-morbidities is frighteningly high. By the year 2030 an estimated 83.4 million people will have 3+ co-morbidities. Compared with 30.8 million in 2015. ( NCHS data brief 2017). AND people with 3+ co-morbidities cost eight times more than healthy people (PWC 2020)
Solution
Key to managing the care of people with multiple co-morbidities is managing the drugs they are taking. PrescienceRx can:
- Identify and stratify any cohort (population) an organization may want to focus on.
- Provide a 360% perspective on that member. Including the following:
- Their estimated cost over the next 12 months.
- The co-morbidities they have.
- The drugs they are taking.
- Their adherence to those drugs and alert if an Rx is not filled.
- Potential Rx to Rx issues.
- The providers they have seen.
Get in Touch
We would love to hear from you! Whether you have questions, feedback, or need assistance, our team is here to help.
Phone
(888) 652-3239
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Address
40 E 94TH Street #13G
New York, 10128 NY
