Health plans
Medical cost trend, provider contracts, payment accuracy, and members whose care falls between programs. Cogitativo helps health plans find what is driving each one and act where action will change the outcome.
Explore Health plansPrecision Health Delivery
Healthcare is personal. Its delivery should be too.
Behind every claim, referral, benefit plan, network contract, and cost trend is a mother, father, sister, or son. Their care depends on how benefits, medical policy, clinician availability, provider contracts and local healthcare markets work together. Cogitativo helps health plans and federal and state health programs connect those decisions with the people they affect, act where a different response can improve care, and measure whether it worked.
Your next decision
What will your organization do tomorrow?
Clinical costs keep rising. Providers are harder to access. Administrative processes consume money and time without improving outcomes. And the care journey is fragmented, organized around the system instead of the person. Disconnected decisions can create barriers to care, avoidable cost, and potential patient harm.
01Rising clinical costs
Use Cognitive CxO to see what is driving cost and why providers differ. Use Visión to see whose chronic condition may be progressing while there is still time to act.
Explore Cognitive CxO02Providers who are hard to access
Use Cognitive CxO network planning to find where your network falls short, by specialty, geography, and the people who need care.
Explore Cognitive CxO03Administrative processes that leak money
Use Conciencia to find the payment patterns that deserve a closer look, and focus your reviewers on the ones that warrant action.
Explore Conciencia04A fragmented care journey
Use Visión to see each person's likely clinical course and the factors associated with it, and to identify care options that fit their needs, so care is planned around the person instead of the system.
Explore VisiónOur productsThree products.
Three products.
Distinct responsibilities.
Visión
Clinical foresight and personalized care journeysSee who is at risk of disease progression, while there is still time to act. Visión recommends the response most likely to help each person and identifies care options that fit their needs.
The right help for each person, while it can still make a difference. Care management dollars spent where they can change outcomes.
Conciencia
Payment integrity, with the judgment built inConciencia pairs decades of payer payment-integrity experience with AI that finds what rules miss. It separates enforceable findings from noise, turns validated patterns into new rules, and traces improper payments to their root cause so they stop recurring.
Findings your reviewers can enforce. Errors stopped at the source, so they don’t recur next year.
Cognitive CxO
Cost, contracts, policy, and networksCognitive CxO is an operational decision platform for health plans and public programs. It connects patterns of care, provider behavior, contracts, policy, and local capacity so leaders can assess how operating choices affect people and the wider delivery system.
Connect operating decisions with the people they affect. Multi-level contract, policy and network decisions you can defend.
Customer account
How Blue Shield used Visión to reach vulnerable members.
Blue Shield of California used the initial release of Visión to support targeted COVID-19 vaccination outreach.
A customer-published account of targeted member outreach.
Blue Shield of California · May 19, 2021
Read the customer account See our work in practice Read the targeted-outreach summary
Precision, in context
See how decisions connect and interact.
Care has to fit the person, but the conditions for care are shaped across the system. A contract change may alter what care is available. An unmet clinical need may reveal where a different network or program response is needed.
Start with the problem, connect the relevant findings, and give each response a clear owner. The question determines which products are needed.
Who we help
Built around your responsibility.
Federal and state health programs
Veterans, service members, tribal communities, older adults, and families with low incomes depend on public programs that buy much of their care from outside providers. Cogitativo helps federal and state payers see where those dollars improve care and where they don't, and act at the level where a responsible team can respond.
Explore federal and state programsCogitativo Knowledge Labs
Bring us your most vexing challenge.
Some decisions need specialized intelligence, not another report. Your Challenge Question is worked by people who have operated national health plans and federal programs, using our proprietary AI. You get back findings, the evidence behind them, and a clear assessment of what they mean for your decision.
Frame your Challenge QuestionSomeone's care depends on what you decide next.
Tell us the decision in front of you. In one conversation, we'll tell you whether we can help, what it would take, and how you would know it worked.
Talk with Cogitativo