THE PLATFORM
Medical, Clinical & Rx
Comprehensive claims analysis and pharmacy management for complete visibility into your healthcare costs and utilization patterns.
Transform Your Claims Intelligence
Our Medical, Clinical & Rx module delivers deep insights into medical and pharmacy claims, enabling proactive cost management and strategic intervention across your entire population. With advanced tracking, profiling, and analytics capabilities, you gain the visibility needed to identify high-cost patterns and optimize care delivery.
Large Claims
Analysis and Watchlist
Unlock comprehensive tracking of high-cost claims with customizable monitoring criteria. Drill down into claims exceeding your defined thresholds and understand the truth behind the data so you can take action confidently. Track profit and loss indicators per group with real-time watchlist alerts for members or groups requiring immediate attention.
Multi-Dimensional
Claims Profiling
Analyze claims, payments, and denials across multiple dimensions including age, gender, provider specialty, condition, service location, revenue code, and length of stay. Identify high-cost services by ED and Urgent Care utilization patterns, with a "Frequent Flier" list of highest users with geographical locations and clinical profiles.
Complete Pharmacy Management
View interactive pharmacy mapping with geographical tracking of patients by prescriptions, prescribers, and treated conditions. Comprehensive Rx analysis shows trends in pharmacy costs over time, drug class prevalence by location, prescription writing patterns, and detailed patient medication profiles with care gap identification.
Personalized Prescriptions through Pharmacogenomic Intelligence
Integrate pharmacogenomic data to enable personalized medication selection based on individual genetic markers that predict drug response. This capability takes pharmacy management from a one-size-fits-all approach to precision prescribing, matching patients to optimal medications while reducing adverse drug reactions and improving therapeutic outcomes.
OUR PARTNERSHIPs
Mark Cuban Cost Plus Drugs
Health Cost IQ has partnered with Mark Cuban Cost Plus Drug Company to amplify our shared mission of reducing healthcare costs through transparency and data-driven insights. Cost Plus Drugs revolutionizes pharmaceutical pricing by transparently charging a standard markup on over 2,300 prescription products, while Health Cost IQ provides the intelligent analytics to identify pharmacy inefficiencies and optimize formulary design.
Medi-Span
Health Cost IQ integrates Medi-Span, the gold standard in pharmacy and medical claims data, to deliver pricing reality that creates a holistic view of patient care. By combining this technology with Health Cost IQ’s platform, customers can optimize formulary management, negotiate smarter, automate prior authorizations, and identify high-cost, low-value drugs for substitution—all while maintaining access to essential medications.
Don’t take it from us – listen to our customers
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