Advanced predictive analytics combining geographic intelligence, environmental health data, claims analysis, and AI disease prediction to optimize quality outcomes and reduce costs.
Comprehensive social determinants of health (SDOH) analysis using real-time data from 5 US Census sources (ACS, SAHIE, SAIPE, CRE, ZBP). Automatically enrich every patient with ZIP code-level insights including income, poverty rates, uninsured rates, healthcare access, pharmacy density, and transportation barriers. Identify pharmacy deserts and care access gaps across your population.
Census Data Sources
Real-time government data
Coverage
All US ZIP codes
SDOH Metrics
Per patient analyzed
Machine learning models analyze comorbidities, geographic risk factors, environmental conditions, and demographic data to predict disease progression and healthcare utilization. Identify high-risk members before expensive events occur.
High-accuracy predictive models
Integrate real-time environmental health factors including air quality, water pollution, climate conditions, and disease outbreak data. Identify populations at elevated risk due to environmental exposures.
Automated pharmacy claims processing with real-time Proportion of Days Covered (PDC) calculation for every therapeutic class. Track medication adherence at population and individual levels, identify therapy gaps, and calculate intervention ROI. Supports bulk claims uploads and continuous monitoring.
Automated Stars ratings tracking and optimization. Monitor performance against national benchmarks, identify members impacting quality measures, and prioritize interventions by Stars impact. Generate CMS-ready reports instantly.
AI-driven cost prediction models forecast healthcare utilization and spending. Identify members likely to become high-cost cases and calculate ROI for preventive interventions. Model includes geographic cost variations and SDOH-driven utilization patterns.
Cost forecast horizon
Executive dashboards with real-time population health metrics, risk stratification views, geographic heatmaps, care gap identification, and alert systems. Customizable views for different roles (executives, clinical teams, analysts). Export reports for board presentations and regulatory submissions.
Process millions of patients with automated batch processing. Upload CSV files or connect via API for continuous data feeds. Intelligent queue management ensures efficient enrichment and analysis at scale.
Automatically identify quality measure gaps, missing preventive services, medication therapy gaps, and overdue screenings. Prioritize closures by Stars impact and cost avoidance potential.
Role-based access control with team workspaces. Different permission levels for executives, clinical teams, analysts, and auditors. Secure data sharing with audit trails and compliance logging.
RxOracle is designed specifically for Medicare Advantage, Medicaid, and Commercial health plans managing large populations. Our platform integrates seamlessly with your existing workflows and scales effortlessly from thousands to millions of members.
End-to-end encryption, SOC 2 Type II certified, BAA included
Onboard in 2-4 weeks with dedicated implementation support
Dedicated account team and 24/7 technical support
Schedule a demo to see how RxOracle can help you improve quality outcomes, reduce costs, and optimize your Stars ratings.