Achieve Optimal Outcomes and Fiscal Integrity with Gray Matter Analytics
Strengthen managed care oversight & transparency
Continuously evaluate MCO performance against financial, quality, and access standards; surface outliers; and guide corrective action with shared, auditable metrics. Recent CMS managed care guidance increases transparency expectations for states and plans; our platform makes compliance practical.
Proactively manage cost and quality performance
Surface emerging trends in cost and utilization, estimate potential savings and direct efforts toward closing care gaps and improving outcomes.
Institutionalize efficiency and enhance reliability
Automate data checks and streamline remediation to ensure timely, reliable data refreshes that strengthen reporting accuracy and enable earlier interventions in care.
Advance health equity & health-related social needs goals
Identify disparities by geography, race/ethnicity, disability and other social factors; measure plan/provider performance; and evaluate interventions.
Optimize value-based contracts
Compare plan and provider performance, model incentives and track results to ensure value-based contracts maintain or improve quality at equal or lower cost.
CoreTechs® Solutions for State Agencies
- 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.
- 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.
- 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.
- 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.
Trusted by:
Gray Matter’s CoreTechs® gives us the capability to manage provider quality and potential cost-savings in both our Medicaid fee-for-service and managed care populations. The solution provides data-driven insights into claims, clinical, and social needs data, providing a whole-person view, while allowing us to generate scorecards regarding member compliance to our providers.
I’ve looked at several different tools, and CoreTechs® is the only one that brings in social determinants of health, contract management and population insights — everything we need to be able to manage contract and follow our patients to see where they are slipping through the cracks.
Gray Matter showed us how we could reduce manual referrals and accelerate care for patients with machine learning that identifies patients who require a referral based on clinical conditions and eligibility information.
Based on the reputation of the management team at Gray Matter Analytics and their ability to demonstrate their understanding of physician performance/value-based care, we decided to become their first CoreTechs® customer. The proof of concept is continuing, and we have very high expectations on the results.
CoreTechs® brought to the surface chronic conditions like diabetes that we had not coded. From that, we learned how to capture and document risk-adjusted factors for shared savings contracts and patient enrollment in disease management programs.
We were at a loss for why our members were seeing providers outside of our network. Gray Matter gave us the analytic tools to understand who would seek an external specialist, when and why. We learned the best points along the care continuum to intervene and even the dollars at risk for each member’s out-of-network choice.
Gray Matter Analytics developed models to help us predict members at risk of postpartum depression so we could proactively offer behavioral health services and take better care of our moms and their families while reducing costs.
Data-driven insights from CoreTechs® guided physician education, code capture, patient outreach and pre-visit planning to help us meet the quality, care and cost expectations of the Medicare Shared Savings Program.
Our team was stretched thin. Gray Matter became our advanced analytics partner and helped us with important work with analytical models and capabilities in CoreTechs® that would have taken years for us to develop on our own.
A lot of times there’s a disconnect between the provider and the payor. With Gray Matter Analytics, we’re looking at the same data.
