Case Study: Global Health Insurance Company improves hospital rating precision with Clarify Health

Global health insurance company improves the precision of hospital ratings for its annual Centers of Excellence designations

A global health insurance company needed a more accurate way to produce its annual Centers of Excellence hospital ratings. Its previous process relied on state APCDs and manual Excel-based analysis, which suffered from stale and incomplete data, inconsistent hospital coverage, and unfair cohort-based benchmarking. Clarify Health, using its Clarify Networks product, was selected to replace that approach with a more modern analytics solution.

Clarify Health implemented an on-demand, machine-learning-driven platform that combined payer-complete claims data with longitudinal patient-level information to produce case-mix adjusted hospital ratings. The solution improved precision, captured all volume through standardized hospital IDs, and made future annual refreshes much faster and easier. As a result, the health plan expected more defensible COE designations, fairer comparisons across hospitals, and better member and provider confidence in the ratings.