Medicaid & Medicare Solutions
Comprehensive data science and analytics services supporting healthcare programs that serve millions of Americans.
15+ years of Medicaid data analytics experience.
Powering dashboards used by state programs and the public.
Identifying and targeting potentially preventable events (PPEs).
Using data to analyze and improve statewide birth outcomes.
Data-Driven Insights
Knowli specializes in transforming vast Medicaid and Medicare datasets into intuitive, high-impact analyses. Our work empowers leaders to improve health outcomes, implement and manage new programs, and ensure financial stewardship with clarity and confidence.
Connected Healthcare Analytics
Integrating data across the healthcare ecosystem
Medicaid Data Analytics
Turning vast claims records into clear insights that improve care quality and program efficiency.
Predictive Modeling
Leveraging machine learning to identify trends, predict outcomes, and optimize healthcare delivery across Medicaid programs.
Performance Metrics
Comprehensive dashboards tracking quality measures, cost efficiency, managed care plan management, and enrollment.
Data Science & Analytics
Knowli supports data-driven decision making with comprehensive data science solutions.
Forecasting & Predictive Analytics
- Identification of potentially preventable admissions, conditions, ED visits and readmissions
- Population trending and forecasting
- Social determinants of health data blending
- Machine learning pattern detection
Modeling Capabilities
- Risk score model selection and application
- Social determinants of health data modeling
- Special population risk scoring and adjustment models
Medicaid Data Management
- Encounter data validation (completeness, timeliness, accuracy)
- Custom ETL, cleansing, and data blending
- Support for NCPDP, CMS-1500, X-12, ENS, EHR, hospital-reported data, provider, and member enrollment datasets and formats
Special Populations Identification
- HIV/AIDS
- Serious Mental Illness
- Substance Abuse Disorders
- Hemophilia
- Private Duty Nursing
Dashboarding & Reporting
- Up-to-date population monitoring (SMI, SUD, HIV/AIDS, PDN, enrollment)
- Service utilization monitoring (ED visits, vaccinations, telemedicine, behavioral analysis)
- Financial reporting and reconciliation (achieved savings rebate, capitation payment monitoring, cost reporting)
Customized Analytical Tools
- Provider network assessment tools
- Data entry tools for analysts
- Progress tracking for contract managers
- Data exploration tools for decision makers
Public Medicaid Dashboards
Interactive dashboards providing insights into Medicaid program performance.
Informed Decisions, Better Outcomes
Transforming complex healthcare data into actionable insight for programs and communities
Birth Outcomes Dashboard
Comprehensive analysis of maternal and infant health outcomes across Florida Medicaid.
View Dashboard →Potentially Preventable Events
Track and analyze preventable hospital admissions, readmissions, and ED visits.
View Dashboard →Enrollment Fast Facts
Real-time Medicaid enrollment statistics and demographic breakdowns.
View Dashboard →Health Plan Transparency Dashboard
A groundbreaking tool providing consumers and stakeholders with unprecedented transparency into health plan performance. Compare plans across key quality, access, and administrative metrics to make more informed healthcare decisions.
- Analyze birth outcomes and preventable hospital events.
- Track access to primary care and mental health follow-ups.
- Evaluate administrative measures like payment timeliness.
- Compare the performance of different health plans side-by-side.
Actuarial & Operational Support Services
Comprehensive support for program management and financial analysis.
Collaborative Excellence
Expert teams working together to deliver comprehensive solutions
Healthcare Expertise
Dedicated professionals improving healthcare outcomes
Core Services
- Eligibility and benefit change impact analysis
- Service delivery and payment model evaluation
- Capitation payment analysis and reconciliation
- Data preparation for capitation payment rate setting across managed care, long-term care, and acute care hospital services
- Specialty population analysis
- System development for evolving programs
Executive Decision Support
- Scenario modeling for executive decisions
- Implementation assistance for program rollouts
- Data preparation for official public communications
- Executive summary preparation for presentations to the Governor’s Office, Legislature, and public workgroups
Health Outcomes Assessment & Metric Development
Knowli's team conducts comprehensive and systematic reviews of Medicaid program utilization, including targeted reviews, profiles, specialized analyses, and decision-support services.
Quality of Care
Comprehensive health outcomes assessments focusing on standards of care, accessibility, and effectiveness
Performance Goals
Value-based performance goals for MCOs, provider groups, and facilities
Birth Outcomes
Primary c-section rate, prenatal and postpartum visits, NAS LOS
Quality Metrics
Coding HEDIS and CMS Core-set metrics
Cancer Screening
Cancer screening adherence tracking and analysis
HIV Care
HIV anti-retroviral drug adherence monitoring
Care Transitions
LTC care-setting transition rate from SNF to HCBS
Managed Care Organization Monitoring
Knowli’s team creates metrics to monitor health plan performance and health outcomes of members over the duration of plan contracts and designs custom tools for ITN scoring and Health Plan contract implementation.
Managed Care Implementation Support
State-of-the-art tools to ensure smooth plan implementations across service sectors
Data-Driven Insights
Advanced analytics powering informed decisions
ITN Scoring Tools
Custom tools for invitation to negotiate evaluations
MCO Readiness
Comprehensive readiness assessments
Progress Tracking
Contract manager monitoring tools
Network Assessment
Provider network evaluation
Additional MCO Services
- Health plan delivery system evaluation
- Reconciliation of plan-submitted financials with claims data
- Contractual goal assessments
- Plan-to-plan comparisons across metrics
- Long-term care program support
- Readiness dashboard for leadership
Federal Reporting
Annual and quarterly analyses for federal compliance
Early & Periodic Screening
Diagnostic and Treatment (EPSDT) comprehensive reporting
CMS-416 Reporting
Annual participation reports for preventive services
CMS-64 Financial Reports
Quarterly expense and expenditure reporting
CMS Audit Response
Comprehensive audit support and documentation
CMS Core-set Measures
Quality metrics and performance indicators
Program Integrity
Fraud and abuse detection technical assistance
Cost Avoidance Analysis
Comprehensive reporting on prevented fraudulent payments
Service Limit Evaluations
DME, behavioral analysis, and home health visits
Rx Relationship Analysis
Enrollee and provider prescription patterns
Risk Selection Analysis
Health plan cherry picking and lemon dropping detection
Provider Network Mapping
Active vs terminated provider relationship tracking
Sentinel Effect Valuation
Deterrent impact measurement of integrity programs
Ready to Transform Your Medicaid & Medicare Programs?
Partner with Knowli to leverage data science and analytics for better health outcomes and program efficiency.