Transforming Medicaid Oversight
CoreTechs® empowers state Medicaid agencies to connect fragmented data, validate MCO performance and surface forward-looking opportunities across compliance, cost, quality and equity.
Contract Insights - Make oversight measurable
Model state-to-MCO contracts with full transparency. Track performance against MLR and quality targets, identify measures at risk, and close gaps before dollars are lost.
Contract performance management: Monitor quality, utilization and spend across MCOs; quantify gaps-to-target and dollars at risk by contract and region.
Encounter/data completeness analytics: Score plans on encounter timeliness and completeness to accelerate T-MSIS/EQRO readiness.
Configurable dashboards: Standardize views for plan report cards, contract risk and cost-savings opportunities.
Performance Insights - See what's working (and what isn't)
Understand PMPM trends, link preventive care to utilization, and assess program effectiveness across populations. Identify avoidable ED visits, network leakage, and high-cost drivers to focus interventions where they matter most.
Plan & provider benchmarking: Compare plans and networks on HEDIS, access, and avoidable utilization; isolate drivers and outliers.
Network & access monitoring: Track service use and leakage; flag emerging access issues for targeted action, aligned with evolving managed care rules.
Intervention impact: Measure results from CAPs, incentive programs, and quality initiatives with pre/post and matched cohort views.
Population Insights - Target risk and improve outcomes
Build and monitor custom cohorts for initiatives like maternal health or social determinants of health. Track outcomes, equity, and cost metrics — all in one place.
Risk stratification & gap closure: Identify high-risk cohorts and missed preventive/condition care; prioritize outreach across plans and regions.
Equity & health-related social needs analytics: Screen for disparities; evaluate services and community partnerships; report progress with standardized metrics.
Care pathway intelligence: Reveal where members fall through the cracks and when to intervene for the greatest effect.
Why State Agencies Chose the CoreTechs Analytics Solution
CoreTechs® supports state agencies in their value-based Medicaid transformation journey, aligning technology, data and insight with the mission to improve lives.
Built for oversight: Shared, source-of-truth dashboards for states and MCOs reduce back-and-forth and enable action.
Data-quality first: Embedded rules and monitors support continuous improvement in eligibility and encounter data, aligned to CMS expectations.
Standards-aligned: Configured for evolving CMS managed care transparency and program integrity requirements.
Security & scale: Enterprise controls and performance engineered for multi-plan, multi-program environments.
