Healthcare Data Intelligence
Your Payer Data Is Worth
Millions.
We Help You Capture It.
Caredatum is the fractional analytics partner for delegated-risk MSOs. We turn your payer data into actionable intelligence — revenue recovery, care gap closure, and risk adjustment gains — in weeks, not months.
No contracts. No long implementations. Results in weeks.
The Problem
MSOs Are Flying Blind
Your payer data arrives in dozens of different formats. Most of it goes unused. The rest arrives too late to act on.
90-Day Blindspot
Claims data arrives months late. By the time you see a readmission, the patient has already bounced back to the ED twice. You're always reacting, never preventing.
Data Fragmentation
Every payer sends different file formats — Humana, Aetna, WellCare, CarePlus — and nobody normalizes them. Your team wastes hours in Excel instead of improving care.
Revenue Leakage
Capitation variances go unnoticed, HCC codes slip through the cracks, and care gaps stay open. You're leaving hundreds of thousands on the table every year.
Based on analysis across 80,000+ members and 30M+ claims
The Solution
One Platform, Complete Visibility
We normalize every payer's data into a single analytics layer — then surface the insights that drive revenue and improve care.
$12M+
Risk Adjustment
HCC revenue opportunities identified for a single client. We surface RAF gaps, suspecting codes, and recapture opportunities automatically.
35K+
Quality Measures
HEDIS care gaps tracked across all payers. Star Ratings, AWV scheduling, and prioritized worklists — all in one place.
$600K+/yr
Financial Intelligence
Capitation variance analysis, underpayment detection, and enrollment gap tracking. Found $600K+ in missed payments for one MSO.
< 15 min
Real-Time Alerts
ED visits and discharges within minutes via Florida HIE integration. 700+ hospitals. No more finding out about admissions weeks later.
Features
Built for Delegated Risk
Every feature is purpose-built for MSOs managing capitated contracts. No generic BI tools — just what you need to optimize risk, quality, and revenue.
HCC Opportunity Finder
Identify RAF gaps worth $1M+ annually. Surface suspecting diagnoses, track recapture rates, and prioritize by revenue impact.
Care Gap Prioritizer
35K+ HEDIS gaps ranked by clinical impact and payer incentive value. Actionable worklists your care coordinators can use today.
Capitation Variance
Found $600K+/yr in missed payments for one client. Automated reconciliation catches enrollment gaps, rate discrepancies, and underpayments.
ED Alert System
15-minute notifications from 700+ Florida hospitals via HIE integration. Know when your members hit the ED before the claim is filed.
Transition of Care
TCM billing opportunities at $201-$273 per episode. Track discharges, coordinate follow-ups, and capture transition revenue automatically.
Member 360 View
Complete member context across all payers in one screen. Diagnoses, prescriptions, care gaps, risk scores, and utilization history — unified.
Real Results
The Numbers Speak
These aren't projections. These are actual findings from our first MSO engagement.
$12M+
HCC Revenue at Risk Identified
for a single 80K-member MSO
35,000+
HEDIS Care Gaps Tracked
across 25K+ members, all payers
$600K+/yr
Capitation Underpayments Found
enrollment gaps + rate variances
< 15 min
ED Alert Response Time
from 700+ Florida hospitals
Conservative ROI: 5–10x within the first year
Process
Live in Weeks, Not Months
No 12-month implementation. No 6-figure setup fee. We get you live and delivering value in under a month.
Connect
We integrate your payer data feeds — Humana, Aetna, WellCare, CarePlus, and more. Automated ingestion via secure cloud pipelines. No IT project required.
Analyze
We normalize 13+ payer formats into a unified analytics layer. Clinical-grade data models power risk adjustment, quality measures, and financial analytics.
Act
Your team gets a portal with prioritized worklists, dashboards, and real-time alerts. Every insight comes with a clear action — no more spreadsheet archaeology.
Case Study
Real Results from Day One
A South Florida MSO managing 80,000+ members across 10+ payer contracts partnered with Caredatum. Within weeks, they had visibility they'd never had before.
$12M+ HCC revenue at risk identified
$600K+/yr Capitation underpayments found
35,000+ HEDIS care gaps tracked across 25K+ members
700+ Hospitals connected for real-time ED alerts
4 weeks From contract to live portal
"For the first time, we can see across all of our payer contracts in one place. The capitation variance analysis alone paid for the entire engagement within the first month."
Chief Operations Officer
South Florida MSO — 80K+ members
Our Approach
Not a Vendor. A Partner.
We're not selling you software and walking away. Caredatum is a fractional analytics team embedded in your operations. We've been in the trenches with MSOs — we know your data, your payers, and your challenges.
Most analytics vendors hand you a platform and wish you luck. We sit alongside your team, interpret the data, identify the opportunities, and help you act on them.
What partnership looks like:
Dedicated analytics advisor — included, not upsold
Monthly strategy sessions to maximize your data's value
Implementation in weeks, not a year-long IT project
No long-term contracts — stay because we deliver value
We handle the tech so you can focus on care
When a payer changes their file format, we've usually already updated the pipeline before you even notice
Healthcare IT Services
Your Technology Partner, Too.
Great analytics require great infrastructure. We offer full-service IT — managed, secured, and built for healthcare. Available for any business, but purpose-built for organizations handling protected health information.
Managed IT Services
24/7 monitoring, help desk, and asset management. Your team stays focused on patient care while we keep the systems running.
Network Infrastructure
Design, deployment, and maintenance for clinic and office networks. Reliable connectivity is the foundation everything else runs on.
Cybersecurity
Threat detection, endpoint protection, and HIPAA security audits. Healthcare is the #1 target for cyberattacks — we make sure you're not the next headline.
Business Continuity
Backup, disaster recovery planning, and DRaaS. When systems go down, patient care can't wait. We ensure you're back online fast.
Cloud Solutions
Azure and AWS migration, management, and optimization. Cloud environments built to meet healthcare compliance requirements from day one.
Unified Communications
VoIP, Microsoft Teams, and collaboration tools. Connect your care teams across locations with secure, compliant communication.
Hardware & Software
Workstation setup, licensing, and procurement management. We handle vendor relationships and volume pricing so you don't have to.
IT Strategy & Consulting
Technology roadmaps aligned to your growth plan. Opening a new practice or consolidating systems — we plan it with you.
Technology Partners
Get Started
Get Your Free Assessment
Tell us about your MSO and we'll provide a complimentary data assessment. No strings attached — just an honest look at where your data can drive more revenue.
What you'll receive:
Capitation revenue recovery estimate
HCC gap analysis and RAF impact
Care gap volume and closure priorities
Implementation timeline and roadmap
Or email us directly at [email protected]
Thank you!
We've received your request and will be in touch within one business day with your free assessment.