Control cost and detect fraud across public health programs.
For state Medicaid agencies, Medicaid managed care plans, and Medicare and other federal program payers that need a clearer view of cost, quality, and program integrity.
Where we can help
- Cost management. Spend by category, per member per month, and by episode, against budget, with the drivers visible.
- Fraud detection and program integrity. Overpayments, improper payment patterns, billing outliers, and audit-ready detail.
- Provider payment. Outliers and value-based payment tracking.
- Reserves and forecasting. IBNR, claims lag, runout, and cost trend projections for budget conversations.
- Quality and HEDIS reporting. Measures built into the workflow so staff spend less time assembling reports.
- High-cost member cohorts. Risk-stratified groups so care teams can reach the right members first.
How we would work with you
Budgets are tightening while quality and reporting expectations keep growing. We built the platform to add a clinical-analytics layer alongside the systems you already run, not to replace them.
Managed care plans can bring their own data without a state procurement, and we make it ready for you to use. State agencies can work with us through your procurement process. We are registered in SAM.gov and in several state vendor portals, and we are open to working as a subcontractor under a prime systems integrator. Our NAICS codes include 541511, 541512, 541513, 541611, and 541720.
Independent by design
OHP does not operate a health plan. We have no competing interest in what your data shows.
The analytics suite for Medicaid
Clinical analytics and financial intelligence on one platform. This is our standard recommended set. More modules are in development, and additional reports are available beyond the dashboards. Open the image to see it full size, or read the list below.
Read the list as text
Tier 1: highest impact
- Diabetes Management
- Chronic Kidney Disease
- Heart Failure Management
- COPD / Respiratory
- Cardiovascular / HTN
Tier 2: growth
- Behavioral Health
- Maternal Health
- Oncology Care Pathways
- Musculoskeletal / Joint
- Obesity / Metabolic
- Polypharmacy
- SDOH Integration
Performance
- HEDIS DashboardsComplete quality reporting
- Physician DashboardQuality metrics & outcomes
- Hospital / ProviderFacility performance & costs
- Fraud DetectionAnomaly & abuse monitoring
Financial dashboards
- Cost & ExpenditureSpend by category, PMPM, episode cost
- Budget vs. ActualVariance, MLR trending, surplus/deficit
- Claims FinancialsPaid volume, adjustments, COB recoveries
- IBNR & ReserveReserve estimates, lag analysis, runout
- Revenue & CapitationPremium by rate cell, DSH, FMAP impact
- Provider PaymentPayments by provider, outliers, VBP
- Program IntegrityOverpayments, FWA recoveries, RAC audits
- Financial ForecastingCost trend, unit vs. utilization, projections
What we will not do
We will not ask for production data before a business associate agreement and a data use agreement are in place. Until then, we can demonstrate on synthetic or de-identified data.
Status. SOC 2 and HITRUST certification are being pursued.
Start with a conversation.
Tell us what your program is trying to learn, and we will show you what that looks like on the platform.