Jay Hammond

Director of Sales

Aggregating actionable data for Caribbean national health programs

By harvesting actionable data, Caribbean national health programs can improve the health of their citizens

PLEXIS Healthcare Systems has completed several successful implementations of our payer platform for national health programs in the Caribbean. Part of our success in the Caribbean stems from the fact that our platform solution helps to identify and manage chronic health conditions within a population, empowering national health programs to improve the health of their citizens.

An essential priority for national health programs is identifying who is sick and who needs help within a population. Experienced actuaries recommend ascertaining exactly which members of a population have chronic health conditions such as diabetes, heart disease, AIDS, and other high-risk conditions. Applying the built-in analysis tools within the PLEXIS platform and our partnering solutions, national health programs can categorize which members are actively controlling their chronic health conditions and which members are not. These are the “controlled” and “uncontrolled” members of a population. According to the World Health Organization, uncontrolled members with chronic health conditions are twenty times more expensive to treat than controlled members.

Effective risk management begins with effective analytics

If national health programs are going to succeed in improving the health of their nation, they must be informed by a centralized technology platform that delivers real-time results. PLEXIS not only built an industry-leading core administration and claims management platform, but we also designed solutions based on the needs of leading healthcare providers, including CEOs of prominent national health plans in the Caribbean.

Aggregating more actionable data

With PLEXIS’ 100% international customer retention rate and our collaborative approach to meeting our clients’ key business needs and values, PLEXIS is ahead of the curve on the technological approach to emerging risk management. Through strategic partnerships and our solid, SQL-based technological foundation, PLEXIS enables clients to aggregate claims and encounter data via real-time portals and EDI sources. PLEXIS centralizes the actionable data from hospitals, providers, pharmacies, and overseas cost containment companies and delivers the output through flexible alerts or ready-made reports.

Some of the additional benefits of implementing the PLEXIS platform and extended business apps include curbing fraud, waste, & abuse; eliminating duplicative & unnecessary services; and saving time by automating complex benefit calculations with PLEXIS’ high auto-adjudication rates. Aggregating data effectively delivers invaluable data intelligence. Once national health programs are informed about the scope of healthcare needs within their populations, they can take more effective and direct action to help manage the health of their citizens.

For information on emerging trends in international insurance, download our white paper, “Modernizing International Insurance Platforms in Emerging Markets.”


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