How GIS is Used

The following core capabilities can be enhanced using GIS technology enabling staff to more effectively carry out all types of tasks for supporting a managed care facility.

Risk
Management
Claims Management
Network Development
Service
Demand

Risk Management

GIS can monitor health outcomes and identify areas where health promotion campaigns could help identify prevention of disease such as emphasizing key health screenings or promoting healthier lifestyles. Managed care organization can also use GIS to identify geographic areas where services are over-utilized.

Claims Management

GIS-based service locators help patients find providers within their network. Managed care organizations can also perform service monitoring to where patients utilizing certain providers are coming from or for fraud detection and mitigation initiatives.

Network Development

Managed care organizations use GIS to analyze communities and enhance the service accessibility of plan members. GIS-enabled web applications can also assist patients with finding providers within their health plan.

Service Demand

GIS provides a mechanism to assess the health care needs of a group to ensure that there are enough providers within certain specialties to meet demand and avoid consumers utilizing health care providers outside of their health plan due to geographic factors or wait times.

 

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