Manage medical cost and find improper payments earlier.
For commercial health insurers that want faster, clinically grounded answers on cost, high-cost members, and fraud, waste, and abuse than claims reports alone can give.
What insurers ask us to look at
- Cost management. Medical cost ratio and budget variance, spend by category and per member per month, trended with the drivers visible.
- Fraud detection. Billing outliers, overpayments, and patterns that warrant review, while they are still small.
- High-cost member cohorts. Risk-stratified groups so care teams can reach the right members first.
- Provider payment. Payments by provider, outliers, and value-based payment tracking.
- Reserves and forecasting. IBNR, claims lag, and runout, with cost trend projections.
- Quality reporting. HEDIS gap closure and regulatory reporting built into the workflow.
Start on your own data
Bring your claims data and we make it ready for you to use. Business associate and data use agreements come before any protected health information, and work can begin on de-identified data.
Measures, benchmarks, and reports are configured to your data and your lines of business.
Independent by design
OHP does not operate a health plan. We have no competing interest in what your data shows, and no reason to steer you toward any product other than our own analytics.
Bring one question. We will bring the dashboards.
Thirty minutes, live, on the cost or fraud question your team cares about most.