April 11 2018

Clarify Health Named a Qualified Entity by The Centers for Medicare & Medicaid Services

San Francisco Bay Area startup continues to expand its extensive data set with the addition of national claims data to support providers with the insights they need to make confident care decisions for patients

SAN FRANCISCO, CA – April 11, 2018 /BUSINESS WIRE/ – Clarify Health Solutions, Inc., a pioneer in machine learning-enabled care optimization, today announced it has been named a Certified Qualified Entity (QE) by The Centers for Medicare & Medicaid Services (CMS).

The CMS Qualified Entity Program enables organizations to receive Medicare Parts A and B claims data as well as Part D prescription drug event data to evaluate provider performance. These CMS claims will be added to Clarify’s growing database. Already rich with more than 2 billion healthcare records on more than 100 million lives, this data powers the company’s care optimization engine. As an approved QE, Clarify Health will incorporate the CMS data into its training data, further improving the veracity of its predictive care models, and providing enhanced value to customers using the Clarify analytics platform, Care Prism.

“Fundamental to the QE program is integrating and analyzing data for the betterment of the public health. With access to Medicare parts A, B, and D data, we are given a deeper view into this national community of patients and providers and can build upon our existing data to develop a more precise understanding of the drivers of cost, quality, and outcomes,” said Todd Gottula, CTO and co-founder of Clarify Health. “Clarify was founded on the mission of personalizing and optimizing every care journey. We’re taking in this new data and making it useful to the clinician at the decision point. Becoming a QE sets us up to propel forward towards the realization of our mission.”

“As a Qualified Entity Clarify has access to higher-resolution data about each patient journey, allowing statistical models to better capture the interaction between risk factors, patterns of care, and patient outcomes,” said Alex D’Amour, Professor, Data Science, Department of Statistics at UC Berkeley. “By unlocking apples-to-apples comparisons of patients who were sent down different care paths, this new data source expands the set of situations in which Clarify Care Prism analytics can provide actionable insights for improving clinical decisions.”

The CMS QE program is highly selective and has rigorous information security guidelines related to the handling and use of healthcare data. Clarify has implemented industry best practice data security and patient privacy protections in order to give customers a safe and efficient platform from which to interrogate their own data at a deeper level; the recent hire of CIO and CISO, Doug Yokoyama further supports that commitment.

About Clarify Care Prism
Care Prism is a powerful analytics platform designed to deliver critical insights to optimize care. The platform delivers fully-case mix adjusted analyses at the individual patient, physician, facility, and affiliated care partner level. Clinicians can rapidly identify variation, better understand patients, and match them to the most appropriate care. Administrators and analysts can more accurately predict performance, allocate resources, and reward staff.

About Clarify Health
Our vision is to power better care by personalizing and optimizing every care journey. Clarify Health delivers the insights and digital solutions that empower physicians, health systems, and payers to optimize care and thrive in a value-based world. The Clarify Health platform seamlessly integrates powerful analytics, artificial intelligence, real-time patient navigation, and smart workflows to proactively guide patients and their caregivers through personalized care journeys. Clarify Health brings together committed and passionate colleagues with backgrounds in big data and AI engineering from financial services together with extensive clinical operations expertise. The team has a track record of achieving over $1 billion in improvement at more than 125 health systems, payers, and pharmaceutical companies, and deploying cloud-based software at over 5,000 institutions.

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The Clarify Care Optimization Platform