Minneapolis is the headquarters of UnitedHealth Group and home to innovative health systems like Allina Health and HealthPartners, making it a national leader in value-based care. We help organizations build the analytics and tools needed to succeed in population health management.
The Population Health Challenge
Success in value-based care requires the ability to identify and engage high-risk patients, close care gaps proactively, and coordinate care across the continuum—capabilities that require sophisticated data integration and analytics.
Our Population Health Solutions
Risk Stratification
Identify patients who need intervention:
- Predictive modeling: ML models predicting hospitalization, cost, and deterioration
- Risk scoring: HCC, CDPS, and custom risk algorithms
- Rising risk identification: Catch patients before they become high-cost
- Cohort analysis: Understand patterns in high-risk populations
Care Gap Management
Close gaps before they impact quality:
- Gap identification: Automated detection of missing preventive care
- Patient outreach: Campaign management for gap closure
- Provider alerts: Point-of-care reminders for open gaps
- Measure forecasting: Predict year-end performance
Care Coordination
Manage complex patients:
- Patient registries: Filterable lists for care management teams
- Care plans: Collaborative planning across providers
- Transition management: Hospital discharge follow-up
- Community resources: Connection to social services
Quality and Performance
Track and improve outcomes:
- Quality dashboards: Real-time measure performance
- Provider scorecards: Individual and practice performance
- Contract analytics: Performance against value-based benchmarks
- Attribution tracking: Impact of interventions
Data Integration
Clinical Data
- EHR integration (Epic, Cerner, etc.)
- Lab and pharmacy data
- ADT feeds for admissions and discharges
- HIE connectivity
Claims Data
- Medical and pharmacy claims
- Eligibility and enrollment
- Provider network data
- Historical utilization
Ready to succeed in value-based care? Contact ZIRA Software to discuss your population health needs.