Elevate health plan effectiveness with
Ventanas – AI Decision Intelligence

Optimize Resource Performance

Increase capacity by augmenting your staff to focus on the highest priority transactions and reduce manual workload.

Elevate Health Plan Effectiveness

Enable instant detection and resolution of coding anomalies, addressing abuse and payment issues, while obtaining proactive insights to guide and align health plan design with leading clinical trends, ensuring the highest value of care for members.

Enable Operational Awareness

Uncover connections between actions and outcomes, influencing both positive and negative results. Identify corrective measures and leverage predictive analytics to anticipate the future impact of implementing changes.

Operational Challenges Come at an Untenable Cost

Ventanas’ flexible platform framework is designed to tackle the most critical payor challenges

Rising Labor Costs

Surging healthcare transactions, including claims and appeals, is driving up costs due to manual processes. COVID-19-related deferred care is adding complexity.

Suboptimal Clinical Efficacy

Insufficient capabilities hinder continuous improvement in chronic disease treatment reimbursement alignment with prescribed regimens.

Collaboration Spending Anomalies

Limited transparency hampers the identification of cost drivers resulting from negotiated partner contracts deviated from industry competitive benchmarks.

Program Effectiveness Opacity

Poor transparency impedes the assessment of operational program effectiveness, including case management, wellness enrollment, and preventative care outreach.

Call Center Surges

Increased call center demand raises staffing costs, extends response times, and results in member dissatisfaction.

Network Performance Obscurity

Inadequate transparency regarding provider network performance and value, making it challenging to identify high-value clusters of care.

Operational Decision Intelligence Platform

Actionable insights guided by nationally recognized data scientists, clinicians, and payer operators

Have a question?

Call us :

(510) 761-7420

Address :

1608 Fourth St, Berkeley, CA 94710