Summary of Business

Certilytics provides customers the most convenient and timely method to obtain products. Subsequent to intake, assembly, cleansing and enriching a customer‘s data sets, Certilytics runs algorithms against the data providing output depending on the specific module purchased. Our Platform-as-a-Service (PaaS) model allows customers to adopt and deploy their results very quickly to their various business circumstances.

History and Background

Certilytics evolved from the ground-breaking modeling, mathematical and analytical work developed by a team of actuaries, data and behavioral scientist and key technology vendors. This work was supported by two key national healthcare firms that served as initial customers as we developed the modeling framework that is the basis of our proprietary “big data” processing platform.

Executive Summary

Certilytics, Inc. Solutions Offers Large, Complex Customers High Value Services and Products

  • We intake, assemble and enrich disparate production data feeds in a data warehouse hosted in our highly secure data center
    • Customer’s data is kept in a unique server domain
  • Proprietary data mining, synthesizing and collaboration of customer‘s data are processed against Certilytic models and algorithms
    • This process enables the predictive features of data
  • Certilytics incorporates into the unique customer data set a series of separate Certilytics data, independent data sources and non-traditional data sets to derive highly unique results for individual customers
  • Proprietary models and algorithms that provide predictive analytics related to risk management, provide profiling and management, population health and management, financial analysis, and risk underwriting and provides the analytic results to customers in dashboards or reports

Unique Features:

The value of Certilytic models are embedded in the fact that they were created using a large data repository for design and testing, and proprietary machine learning processing formulations. The combination of data set size and sophisticated processing yields the most accurate and predictive models to run customer data sets against, resulting in high value outputs for customers

  • Proprietary data management processes ensures data for customer models and outputs is valid
  • Models and algorithms are developed using large data sets. This improves the predictive features of the models and outputs
  • Algorithmic design, data science and engineering expertise that results in the most insightful modeling and data mining applications
  • “Big Data” processing techniques that use machine learning, artificial intelligence and other state-of-the-art data processing strategies are used to obtain the most sophisticated and most highly predictive results
  • Use of open source and distributed processing technologies to have the fastest, most secure and scalable processing infrastructure

Key Trends:

  • Predictive health information and collaboration is helping find the combination of treatments and services that can lead to better patient, provider, and economic outcomes
  • Hosted analytics, partnerships and collaborations, and lower-cost internal applications are opening the door for smaller organizations to use big data
  • Data warehousing and analytics used to be restricted to larger organizations because it was cost prohibitive
  • Automation of compliance is important
  • Healthcare CEOs want to know how their organizations can use these tools
    • In a PWC study, 95% of healthcare CEOs said they were exploring better ways to harness and manage big data
  • Healthcare providers are taking on more risk
    • To manage risk and treat patients most appropriately, providers need accurate data from a range of sources

Our Solutions:

  • We made investments so you don‘t have to
    • Our technology exploits the speed and processing power of distributed computing and parallel processing
    • Our proprietary processing platform processes massive data at processing speeds that are necessary to obtain the level of correlation and predictive analytics results in a timely and efficient manner
    • This highly-scalable, failure-resistant data management solution allows customers the flexibility to avoid costly internal changes to legacy IT infrastructure, and ensure their data retains the high value inherent in their production data sets
  • We provide access to the technologies and discovery methods that can process and data in conjunction with proprietary data mining, models and algorithms to provide predictive analytics to assist in creating enhanced clinical, financial and operating business decisions
  • We produce results where the quality of each result is enhanced
    • We use our enriched models and comparative results from much large data sets in our data warehouse
    • We have over 100M clinical experience anonymized data sets that provides highly accurate models and algorithms
  • Smaller organizations can use big data
    • For example, a customer provides Certilytics data that represents 1M lives
    • We intake and assembly that data set, and run our models and algorithms for those 1M lives
    • We then compare the predictive analytic results against results processed against 100M anonymized lives data set - improving the analytic results for each unique customer
    • It‘s simple
    • You cannot have “big data” analytics unless you have massive data sets to use in developing your models and comparatively processing smaller data set results
    • Certilytics data warehouse continues to grow daily, thereby improving the predictive and reliability of it‘s models and algorithms

Summary of Business

Certilytics commercially-available models

  • Data Services (Security, Assembly, Cleansing, Integrity, Enrichment - “SACIE”)
  • Provider Profiling
  • Financial Forecasting, Risk Underwriting and Assessment, Modeling
  • Population Health Management, Behavioral Science
  • Payment Integrity

This comprehensive product suite offers solutions to health plans, health systems, providers and employers as they adopt their business to more highly competitive underwriting, member engagement and payment reformation environments. Certilytics maintains an ongoing research and development effort to provide customers with both standard new releases of products, as well as the capability to design and install customized features to each module.

Our most important contribution to the data science of customers is SACIE. This proprietary approach takes customer data sets and ensures those data sets are cleaned, enriched and secure before any processing or analytics are applied. Customers have the option to contract with Certilytics to provide only the Data Management service.

Platform as a Service (PaaS)

Certilytics provides products and solutions through a PaaS delivery method. This simplifies a customer’s path to rapidly deploy and utilize Certilytics products in meeting their business and clinical objectives. Customers can efficiently provide data feeds and relevant data sets via Certilytics secure data ingestion protocols; the data is cleaned and enriched. Depending on what modules a customer has contracted for, Certilytics’ platform processes and reports results to customers in a timely and confidential manner. Customer data sets only reside in Certilytics secured data center based in Minneapolis, and no data is shared, transferred or accessed without explicit compliance to regulatory and customer contractual provisions. Certilytics does not use any offshore or cloud-based data storage or processing capabilities.

How We Sell our Products and Services

Certilytics provides customers the most convenient and timely method to obtain products. Customers pay a service fee based on the number of lives in their data base. Subsequent to intake, assembly, cleansing and enriching a customer’s data sets, Certilytics runs the commercialized algorithms against the data on a monthly basis, and various outputs are provided to the customer depending on the specific module purchased. Our Platform-as-a-Service (PaaS) model allows customers to adopt and deploy their results very quickly to their various business circumstances.

History and Background

Ground Breaking Work

Certilytics evolved from the ground-breaking modeling, mathematical and analytical work by selected teams of actuaries, data and behavioral scientists, and key technology vendors. This work was supported by two key national healthcare firms that contributed large anonymized data sets and key personnel to develop the modeling framework that is today have been commercialized in Certilytics proprietary “big data” processing platform. To take advantage of today's “big data” processing and analytical capabilities, you fundamentally require and need “big data” sets and a warehouse.

Key Foundational Partners

Certilytics has been conducting research and development since 2007. In addition to Certilytics internal design and engineering teams, partnerships with ColdLight Solutions, Inc. and PathSight have supplemented the design and unique computing features. The research effort has been uniquely assisted by Certilytics relationship with the Institute of Scientific Interchange (ISI). These partners remain under contract to Certilytics in continuing the research and development efforts to support the long-term and continued evolution of the models and algorithms.

Most importantly, Certilytics was joined in this research and commercialization effort by two major healthcare entities. Both partners contribute anonymized data sets that are foundational to applying “big data” technologies and algorithms.

  • Anthem contributes financing, and clinical and technology teams to support the development of advanced analytic models in support of their payment integrity, underwriting, risk management and provide networking activities.
  • Express Scripts contributes financing and members of their unique Innovation Laboratory in the design and commercialization of specific analytical models primarily related to the use and adherence to pharmaceutical aspects of behavior and outcomes.
  • ColdLight Solutions provides additional engineering team members and expertise in unique machine learning and artificial intelligence from non-healthcare data sets and insights in the design and programming of our algorithms, and independently test those algorithmic outputs.
  • PathSight provides behavioral-data scientist to independently develop and test new, changing algorithmic formulations for specific test cases that customers present, and the fundamental behavioral criteria and algorithms that supplement core actuarial and clinical analytics for each model. The Institute of Scientific
  • Interchange (ISI) is an independent, resident-based research institute known for work in complex science, theoretical and mathematical physics located in Torino, Italy. ISI was founded in 1983 and its mission focuses on promoting scientific interchange and cooperation at the highest degree of quality both in terms of creativity and originality of research and to represent a pillar of high level interdisciplinary training.
  • Carewise Health, Inc. provides data management infrastructure and a full range of nurse clinician resources in support both product design, but importantly supporting customers who desire to base new implementations of care management and payment integrity initiatives based on Certilytic analytical models and outputs.

Our Commercial Models

Initial alpha product offerings were first put into production during 2012-13 covering:

  • Provider Profiling
  • Population Health
  • Financial Forecasting, Risk Management and Underwriting
  • Payment Integrity

Certilytics is a privately-held Delaware Corporation with offices in King of Prussia, PA.

Design and Engineering Leadership

Charles Bloss, SVP & Chief Actuary/Product Design

Joseph Cook, SVP, Strategic Customer Support

Robert Dwyer, VP, Senior Data Scientist

Sue Gabinelle, RN, Lead Clinical Design

David Hutton, VP, Senior Data Scientist

Eugene Kwak, Lead, Payment Integrity Data Analyst

Mark McLane, Lead Engineer

Andrew Ottum, VP, Consulting Lead (Analytics and Actuary)

Elton Tavenner, SVP, Chief Technology Officer

Technology Platform

Certilytics has adopted one of the most important and state-of-the-art technology approaches designed to securely intake, process and store the significant amounts of customer clinical, insurance, financial and operating data sets used in providing our products and services. We combine the technologies from Hadoop, DataGuise, Pentaho and Microsoft to provide a best in class processing platform that is equally proficient at processing massive data sets. Our unique applications make up our proprietary analytic models, in a manner that allows us to efficiently scale our product offerings.

Certilytics’ proprietary processing platform is based on latest open source technologies that employ various features, both commercial and proprietary, of machine learning, artificial intelligence and algorithmic intellectual property to identify and deconstruct unique patterns, trends, predictive features and relationships amongst the terabytes of data elements ingested, enriched and processed by Certilytics.

Standard and Customized Models

Often times, in addition to using our standard product models, customers often want to design and obtain outputs that answer unique or more complicated questions about their businesses. We maintain a core group of data scientist and engineers that “skunk work” analytic solutions for our customers. These typically highly confidential projects will link both customer data sets with non-traditional data sets and algorithms to determine highly proprietary results.

Data Warehouse

In addition to highly sophisticated and unique models that mathematically change and evolve constantly, Certilytics has one of the largest health care data warehouses. The warehouse contains clinical, statistical and financial data on over 100 million lives. The warehouse continues to grow on a daily and monthly basis. We expect it to grow by over 200 million lives in the next 12 months. We host customers and their IT engineers and compliance auditors in assessing our data security, confidentiality and integrity. Certilytics does not use any offshore or cloud-based data storage or processing capabilities.

Our business model allows our customers to avoid costly acquisition and purchases of software, and the highly complex, burdensome and time-consuming process of installing and operating new software within their highly complex IT environments. Most importantly, they get the models, reports, dashboards and analytic results more rapidly to apply to their business solutions and objectives. Our large, complex customers avoid the debilitating challenge of getting actionable analytics through their legacy IT systems. The value of Certilytics to securely intake, assemble, cleanse, enrich, process and store their data, in a timely and efficient manner, is the one of the most advantageous features. Our engineers and data scientist have both deep technical expertise, but also know the unique features of health care informatics.

Key Trends and Issues

Customers must master data analytics to succeed in the new world of healthcare. In a recent study:

  • Population health management fuels much of the interest in analytics: 41% of respondents are now doing analytics on health data from a defined population, and another 48% either expect to do so in a year or are investigating.
  • Internal analytics is no longer enough. Although only 17% of respondents do analytics with clinical data from partners' EHRs, an additional 57% either expect to do so within a year or are investigating how to get started.
  • EHR interoperability and the integration of clinical and business data (54%) as their biggest challenges.
  • Support for coordinated care cite the need to among the top strategic drivers of their IT efforts (43%)
  • Data Scientist and Analytics staffing shortages are a real problem. More than half of respondents (53%) say that insufficient skills in analytics are among their top near-term tactical challenges. More than one-third (38%) expect to add analytics-savvy staffers within the next year, and 43% will invest in analytics training.

Security and Compliance

Our Office of Compliance is continually monitoring to ensure company standards, regulations, board decisions, laws and other policies are followed precisely. All company employees participate in educational and training programs to ensure every person is knowledgeable of and in compliance with pertinent standards. Always looking for opportunities for improvement, the compliance team makes regular recommendations for how to better execute these standards in daily operations.

Certilytics is the first healthcare vendor to adopt a “Bi-Lateral Diligence” security assessment protocol. For new and existing customers, Certilytics joins with the customer and their technical security assessment teams to perform simultaneous security assessments of one another. This process materially enhances the security controls of both parties.

Security assessments are performed routinely for all customers, and our specialized team works directly with every customer's specialist to ensure complete security coverage.