Vivida Health: Customer Success Story

Vivida Health, a Managed Care Organization (MCO), needed to comply with State of Florida Healthcare Payment Integrity Requirements within their first year of operations. Their investigations consultant Justice Group activated Alivia Analytics FWA Finder™.

As a result, Vivida Health was able to achieve more:

• Uncovered dozens of new fraud schemes that were previously unknown to them
• Automated quarterly and annual reporting requirements
• Increased case volume by 1000% without needing to add additional staff
• Received State of Florida certification

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Pacific Blue Cross: Customer Success Story

Pacific Blue Cross needed to accurately forecast their high-cost drug spend. If they overestimated the amount, they would overcharge their large corporate customers and risk customer churn. If they underestimated the future charges, Pacific Blue Cross would suffer direct losses. Pacific Blue Cross turned to Alivia Analytics Outcome Simulator™ to deliver accurate predictions for their high-cost drug spend.

As a result, Pacific Blue Cross achieved more:

• 10x increase in high-cost drug spend accuracy
• Reduced customer churn
• Increased the bottom line

"Our risk management team is able to leverage the Alivia Analytics Outcome Simulator™ - its robust machine-learning capability helps us better project our pooled costs for our clients. Our previous forecasting system relied heavily on pooled costs remaining relatively static over time, even though these costs tend to fluctuate drastically due to changes in the client’s member population or other exogenous events, like COVID-19. With Alivia Analytics Outcome Simulator™, we are now able to dynamically adjust our rates to match the ever-changing landscape around us, making us a nimbler business equipped to confront hard-to-predict, unforeseen events." - Jason Welch, VP of Group Business

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