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Certilytics, Inc. Releases Nucleus Data Warehousing + Predictive Analytics

Nucleus Creates a Complete Picture of Member Health, Utilization, and Risk

Certilytics, Inc. announced the release of Nucleus Data Warehousing + Predictive Analytics, combining sophisticated healthcare data management with Certilytics’ advances in operational data science, actuarial insights, and product development on a powerful healthcare predictive data analytics platform.

Nucleus empowers healthcare organizations employers, employer groups, benefit managers, health plans, and provider health systems—to optimize benefit programs, improve care delivery, and manage costs by creating a single data repository that offers a complete picture of member health tightly integrated with the powerful predictive analytics products available from Certilytics. Nucleus gives customers access to the data “behind the scenes” to develop new insights by integrating the data warehouse layer with their own data discovery tools, business intelligence platforms, and custom applications.

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“Nucleus collects, links, standardizes, and validates data from disparate sources to create a complete picture of member health, utilization, and risk,” said Elton Tavenner, Certilytics’ Executive Vice President and Chief Technology Officer. “By combining that advanced underlying data warehouse with our data platform and innovative product offerings, we’re empowering our customers with more than ‘just another data warehouse’ by giving them the tools to take the leap from disparate data to transformative knowledge.”

Among other capabilities, Nucleus Data Warehousing + Predictive Analytics:

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  • Links disparate data-sets and generates a globally unique ID for every employee, member, or patient
  • Includes sophisticated proprietary validations to ensure the quality, accuracy, and reasonableness of all data
  • Is capable of regularly processing billions of member data records, including:
    • Claims (medical, pharmacy, dental, & vision)
    • Benefits & eligibility
    • Lab results
    • Clinical management programs
    • Disability benefits
    • Third-party technology platforms
    • Others
  • Enriches data with hundreds of tags and measures, including our proprietary clinical episode grouper CORE Pathways
  • Includes easy-to-understand aggregations of underlying data to provide simple and consistent reporting
  • Seamlessly and securely shares data via JDBC, API, and BI integrations

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Nucleus is the foundation for all of Certilytics’ advanced predictive analytics solutions, including the Aspects Suite’s dashboards, data extracts, and reports.

The integrated predictive analytics in the Aspects Suite are used to:

  • Benchmark clinical and financial results against national norms, peer groups, business units, or geographies
  • Evaluate the performance of employee benefit programs and optimize benefit investments
  • Generate a standard set of proprietary reports to assess, manage and measure risk, including:
    • Employer group reporting
    • Individualized member clinical profiles
    • Medical management reporting
    • Pharmacy management
    • Provider profiling
    • Actuarial reporting (trend, pricing, and reserving)
    • High cost claimant reporting
    • Insured run rate reporting
  • Identify, report, and benchmark cost trends, provider treatment patterns, condition severity, and health outcomes across billions of member records
  • Perform sophisticated analysis at the member level into complete episodes of care, utilization patterns, emerging disease onset, gaps in care, and each member’s likelihood of engagement
  • Develop high-performance provider networks supporting fee-for-service and value-based arrangements
  • Evaluate care pathways and predict future costs for a given condition
  • Review performance, perform risk assessments, and analyze spend, helping business and clinical leaders make more informed decisions

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