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1Clearsense™ Data Analytics & Interoperability Platform

Empowering Payer Organizations with Advanced Healthcare Data & Interoperability Solutions.

Streamline operations, enable robust data-sharing transactions, and

bring transparency and consistency to data.

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At Clearsense, we understand payer organizations’ challenges in aggregating and managing disparate healthcare data sources while ensuring data quality and trust. That’s why we built the 1Clearsense data platform. The Clearsense Healthcare Data Model drives this platform—a highly mature and robust domain model that aligns with FHIR interoperability standards. With this domain-based model, Clearsense helps payer organizations easily aggregate disparate data sources and focus on utilizing the data quickly. From claims to clinical data, 1Clearsense allows for seamless aggregation, enabling richer data analytics, closure of care gaps, improved risk adjustment, and reimbursement accuracy.

Partnering with Clearsense means accessing our existing relationships with numerous large healthcare organizations. We facilitate seamless data integration, aggregation, and collaboration, minimizing friction in workflows and transactions while ensuring efficiency in data-sharing agreements. Our comprehensive approach manages all transactions and data, from source to target. With data quality and trust as priorities, we enrich shared data with organizational data, third-party benchmarks, and in-line analytics. Data owners have complete control over security and access policies, guaranteeing that only authorized entities can access sensitive information.

With a focus on data ingestion, management, and consumption, the 1Clearsense Platform allows payers to:

  • Enable robust data-sharing transactions, including ADT messages, CCDs, and claims.
  • Aggregate diverse patient and member data into unified domains for analysis, insights, and visualizations of healthcare needs, outcomes, and behavioral patterns.

  • Act as an all-in-one solution for clinical data aggregation and enforcement of data quality standards in compliance with NCQA’s data aggregator validation (DAV) program.

  • Continuously monitor changes to data and data quality to produce notifications and alerts, enabling payers and providers to take action on updating provider demographics, credentialing, network assignment, point of care alerts, and other critical information.

  • Leverage accurate provider data and aggregated clinical data to produce out-of-the-box STAR Rating analytics targeting opportunities to improve performance.

  • Produce intuitive visualizations of the member journey that readily identifies trends in cost and utilization.

The Clearsense Approach

1Clearsense, an all-in-one healthcare data platform, aggregates data from various sources and is powered by the Clearsense Healthcare Data Model. This model offers pre-built integrations and accelerators to rapidly implement connections, mapping, and data quality rules, ensuring data lineage and traceability. With payer and provider data residing within the common healthcare data model, organizations can determine the source of truth and assign trust rules.
Collaborating with organizations, Clearsense establishes granular data access policies and assigns security controls. Accessible data can be seamlessly utilized in 1Clearsense analytics, outgoing integrations, and customized applications through 1Clearsense's bring-your-own-tool (BYOT) capabilities.

Seamless Communication and Data Exchange

The intelligent interoperability functionality of 1Clearsense supports common healthcare messages and transaction types, including CCDs, ADT messages, and claims. These transactions can be processed in real-time, near real-time, and batch using healthcare standards such as HL7, FHIR, USCDI, and EDI X12. Clearsense can also aggregate and normalize data into these standards when accessed directly from EHR databases or other applications through point-to-point connections. The 1Clearsense data quality and business rules engine can also harmonize and enrich data for use in analytics and process automation. The result is less manual work, fewer disparate tools, and more time for innovation and meeting market demands.

Next-Generation Data Management

1Clearsense features next-generation data management that gives payer organizations access to over 1000 pre-built data integrations, accelerating data mapping, application of data quality rules, managing reference data, and supporting other data governance functions. The Clearsense Healthcare Data Model and accelerators enhance scalability, agility, and flexibility. Payers can manage data once and apply their work across multiple use cases, including risk assessment, quality management, cost analysis, and utilization tracking. Our data management tools allow for intuitive collaboration by stewards and ensure the highest quality and trust of data. 1Clearsense also empowers payers’ analytics teams to extend their existing analytics quickly, confidently build advanced analytics, and adapt to evolving business needs.

Data Ingestion

Seamlessly bring data from disparate systems into a single, unified platform.

Data Management

Maintain and manage all technical & business metadata, master & reference data, data quality, & analytics governance.

Data Consumption

Manage and view data with multiple lenses necessary for clinical, financial, and operational use cases.

Self-Service Analytics

1Clearsense offers out-of-the-box, self-service analytics tailored to core payer needs for value-based care, such as quality, risk, and utilization. Our analytics empower care management, risk optimization for your actuarial staff, and other population health analytics and network performance management. 1Clearsense is designed for the intuitive exploration of data with the ability to create individual member outreach programs that enable care coordination and informed decision-making for your member population. Clearsense 20/20 unlocks predictive analytics for social determinants of health (SDOH), disease management, and behavioral health, enabling analysts to go beyond descriptive insights to make data-driven recommendations. 1Clearsense seamlessly integrates transactions and automations, empowering payers to deliver better quality management and risk adjustment while enhancing member engagement and individualized care.

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Featured Payer Use Cases

Payer-Provider Collaboration

Reduce manual transaction processing activities, improve accuracy for optimal claim submission and CMS reimbursement, enhance quality reporting and care gap closure, and shorten critical member and patient follow-up times for improved outcomes.

Provider Network & Data Management

Reduce manual intervention for staff, enhances claims adjudication accuracy, improve network adequacy decisions, enable care gap closure, validate provider credentialing and member assignment, and boost provider performance reporting accuracy.

Network Performance

Target providers for appropriate care for representative populations by geography and demographics, track member journeys to identify at-risk members, reduce utilization with preventative care, identify high-use utilization trends for care coordination, and strategically expand network services to serve members better.

Value-Based Care

Harness the power of advanced analytics and seamlessly integrate workflows to enhance Star ratings, HEDIS quality measures, and MIPS reporting, drive quality adherence for members and patients, and provide physician score carding to boost financial outcomes.

Why Payers and Payviders Choose Clearsense

Data Aggregator

Facilitating the seamless and transparent exchange of information between healthcare providers and payers in compliance with NCQA DAV certification.

Robust Interoperability

HL7 and FHIR-enabled platform supporting common healthcare messages and transaction types, including CCD, ADT messages, and claims, following healthcare standards, including USCDI and EDI X12.

Velocity and Agility

Leveraging the Clearsense Healthcare Data Model, 1Clearsense scales to accommodate your organizational growth and rapidly responds to market demands with unmatched velocity.

Leverage the Strength of Your Data

Are you ready to for a trusted and transparent view of your data and analytics?

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