Payers
Risk adjustment, quality performance, and utilization are all constrained by the same structural issue: the underlying data arrives after the opportunity to act on it has passed.
the problem
Three things decide the year: capturing member risk accurately, closing quality gaps before they cost you, and managing utilization without compromising care. All three depend on data that sits across claims, clinical records, and supplemental feeds, and almost none of it surfaces in time to act. By the time the gaps and the high-risk members show up in a report, the measurement year is often already gone, and so is the chance to do anything about it.
risk capture that lags the measurement year
quality gaps found too late to close
utilization trends you see only in hindsight
how Hiive helps
Hiive AI Insights brings your claims, clinical, and supplemental data into one governed environment and surfaces what matters to plan performance, in time to move on it. Your risk adjustment, quality, and medical economics teams get answers in plain language, in their own dashboards, without waiting on a data science team. It's built on an enterprise AI platform with 8 years of production history and deployed in weeks.
what plan teams use it for
prior auth pattern analytics
see where authorization patterns are creating friction or risk across your network
population health
cohort stratification, readmission prediction, and targeted member outreach
quality & HEDIS
HEDIS gap closure and preventive care targeting, surfaced while the measurement year is still open.
utilization intelligence
monitor throughput and cost trends and forecast high utilizers before they drive avoidable spend
risk model forecasting and gap identification
Forecast risk scores and surface documentation gaps against whichever risk model your program runs on, and capture member acuity accurately and on time.
proof
Hiive AI Insights is running in production at a leading national health system, not in a pilot. It unifies your claims, clinical, and supplemental data into a single governed layer, with full audit trails on every model and decision. HIPAA and SOC 2 Type II compliant from day one.
governed & audit-ready
HIPAA and SOC 2 Type II, with full lineage on every model and decision, so nothing happens in a black box.
built to reach your data
unifies claims, clinical, and supplemental sources rather than leaving them in silos.
platform maturity
8 years of production AI in large, data-intensive healthcare environments.
Twenty minutes with the platform and your questions. We will show you what the current reporting cycle is hiding.
