Population
Health

Leverage analytics to identify risks, drive quality improvement, and achieve better health outcomes across the holistic needs of the entire population

VALUE

Advanced analytics to predict risk, identify care and equity gaps, understand factors affecting outcomes, and flag opportunities for intervention

Customized rules-based engine to recommend enrollment in care management programs

Integrate SDoH and behavioral health services to address whole person needs

DIFFERENTIATORS

Market-leading analytics algorithms deployed on over 8 million lives to date

Tailored reporting on cost, quality, population health trends, and outcomes

Actionable insights to optimize risk-adjusted payments, provider performance, shared savings allocations, and care plans

Population Health Features

Stratify risk, assign conditions, create panels, and present relevant information in dashboards

Patient risk scores assessed

Patient risk scores

Predictive risk models to stratify patients by various categories of risk

Support for risk adjusted payment models

Identification of gaps in care at the individual and population level

Condition markers

Algorithms and rules to assign medical, behavioral health, social, and other condition markers

Scored and validated assessments to evaluate additional risk factors

Rule-based registries, panels

Rule-based registries to identify panels of patients meeting specific criteria for eligibility, qualification for enrollment in care programs, and specific interventions

Standard & Custom Dashboards

Aggregate risk by patient, provider, and payer

Create cohorts to evaluate the efficacy of programs

Dashboards to gain insight into cost, quality, outcomes, access and other measures

Drive Quality Improvement

Example use case Description
Provider quality oversight Identify performance of providers at an individual and practice/system level from a cost and quality perspective relative to their peers. Each provider is assigned an overall score.
Quality management reporting Access out-of-the-box reports and dashboards or customize reports to meet your specific needs.
Care program enrollment recommendation engine Implement a customized rules-based engine to automatically assign patients to care management programs.
Care equity analysis Leverage visualizations and dashboards to analyze utilization, access and outcome data through a health equity lens.
Early psychosis identification and intervention support Advanced analytics to identify early psychosis, identify care and equity gaps, flag opportunities for intervention, and monitor team-based care delivery against evidenced-based standards

"I’ve had to do direct service recently due to staff shortages. When I'm assigned a new case, the first system I log into is the SyntraNet Community Health Record. There, I can see the complete history of the client all in one place: a list of providers, if they had been to the emergency room or were in jail recently, if they were homeless and even if they had their COVID vaccine. It has saved me a ton of time and let me jump right into problem solving."

– Jamie Almanza,
Executive Director of Bay Area Community Services

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