Predictive analytics platform that turns claims data into proactive patient care
Digital Scientists partnered with Congruity Health to research, architect, and launch an MVP healthcare analytics platform—ingesting claims and eligibility data in real time to identify at-risk patients and trigger telehealth interventions for chronic disease management.
7,020
Enrolled Patients Tracked
968
Intervention Triggers
58.84%
Patient Enrollment Rate
$109K+
Cardiometabolic Savings Identified
A data-driven approach to chronic disease intervention
Congruity Health approached Digital Scientists to create the foundation for a sustainable data ingestion and analytics platform that could provide meaningful insights and efficiency to insurance providers and their customers. The project is a prime example of our population health management solutions. The goal: proactively and predictively target patients in need of care by increasing access and accountability for targeted chronic disease management.
Digital Scientists provided end-to-end product development services, beginning with a discovery and alignment workshop, competitive research, stakeholder and journey mapping, and user interviews. The team then produced a comprehensive solution architecture document evaluating technology options across every pipeline component before building through data pipeline development, rules engine implementation, CRM integration, and analytics dashboard configuration.
The platform analyzes claims and eligibility data in real time for musculoskeletal and Type II diabetes diagnoses, identifying health event triggers and possible points of intervention. This level of healthcare interoperability and FHIR integration enables telehealth providers to proactively reach out to patients with preventative measures, reducing healthcare costs while improving patient outcomes.
Turning fragmented claims data into actionable healthcare intelligence
Congruity Health needed to build an ingestion and analytics platform that could provide real-time analysis of claims and eligibility data for musculoskeletal and Type II diabetes diagnoses, codes, and procedures. The platform had to identify health event triggers, predict intervention opportunities, and seamlessly integrate with telehealth providers to close the gap between data insights and patient action.
Disparate Data Sources
Claims, eligibility, and clinical data spread across multiple TPAs and provider systems with no unified pipeline for analysis.
HIPAA & PHI Compliance
Every component of the solution architecture required careful planning for security, privacy, and HIPAA-compliant handling of protected health information.
Reactive Care Model
Without predictive triggers, patients only received care after costly health events—missing the window for preventive, lower-cost interventions.
No Analytics Visibility
Employers and TPAs lacked dashboards to track intervention efficacy, cost savings, and enrollment trends across their self-funded health plans.
Crowded Competitive Landscape
Established players like Innovaccer, Health Catalyst, and Artemis Health dominated the space, requiring clear differentiation in self-funded employer focus and telehealth integration.
CRM Workflow Integration
Telehealth agents needed intervention triggers delivered directly into their Salesforce CRM workflow—no separate logins or manual data lookups.
What employers and telehealth agents needed to accomplish
Identify high-risk patients from claims data before costly health events occur, using predictive analytics to flag intervention opportunities
Receive automated outreach tasks in the telehealth CRM with patient context, trigger reasons, and health history for informed conversations
Track enrollment rates, intervention program efficacy, and cost savings over time through executive dashboards accessible to C-level management
Forecast patient costs and visualize spending trends across cardiometabolic and non-cardiometabolic conditions by quarter
Prove lower cost of care through value-based transparency, showing employers exactly how interventions reduce total cost of care
Increase telehealth enrollment for chronic disease patients, targeting musculoskeletal and Type II diabetes conditions with proactive outreach
Alignment workshop, competitive analysis, and journey mapping
Digital Scientists led a comprehensive discovery phase that aligned all teams around a single product vision: increase access and accountability for targeted chronic disease management in order to drive down total cost of care. This research-driven approach validated product positioning and identified clear differentiation opportunities.
Alignment Workshop
The workshop created a shared understanding of audience, problems being solved, benefits for users, challenges, and differentiation strategy. Key themes identified included driving down employer costs, proactively targeting patients in need, and providing value-based transparency.
A stakeholder map revealed the primary platform user—the Agent (typically a nurse)—along with physicians, employer C-level executives, telehealth leadership, and enrollment marketers as key personas.
The MoSCoW prioritization exercise defined must-haves including demo dashboards with mock data, Salesforce integration, MVP dataflow, and live PHI utilization—while explicitly scoping out a patient-facing portal and payment portal for the MVP.
Blue Ocean Competitive Analysis
Digital Scientists conducted a Blue Ocean Strategy analysis evaluating 7 direct competitors—including Innovaccer, Health Catalyst, Artemis Health, Inovalon, Evolent Health, Health EC, and SPH Analytics—across 8 strategic dimensions.
The analysis revealed key differentiation opportunities: while most competitors offered population health management, none specialized in self-funded employer plans with integrated telehealth. Automated interventions were the weakest area across the competitive landscape—most platforms stopped at recommendations, leaving employers to act on their own.
This research directly shaped the platform's positioning: actionable AI-driven data with automated telehealth triggers, targeted at self-funded employer healthcare plans.
A four-stage data pipeline from ingestion to intervention
Digital Scientists produced a formal solution architecture document that systematically evaluated multiple technology options for each stage of the data pipeline. The team assessed cloud providers, data warehousing platforms, BI tools, rules engine approaches, and integration strategies through detailed comparison matrices—weighing scalability, HIPAA compliance, cost, and time-to-MVP before recommending the final stack.
The resulting architecture follows a four-stage data service flow: secure data ingestion via FTPS, transformation through a cloud data warehouse, AI-driven trigger generation via serverless functions, and delivery to both CRM and analytics dashboards. A deliberate multi-cloud strategy leverages the strengths of both AWS and Google Cloud Platform across the pipeline.
Data Ingestion
Data is ingested via a secure, client-specific FTPS. Claims and eligibility files from TPAs are loaded on a dynamic cadence, with direct API capabilities available for real-time feeds.
Analysis Engine
From AWS S3, data transfers to Google BigQuery for transformation and querying. A proprietary rules engine and ML models apply trigger logic to identify intervention opportunities, from simple care gaps to critical cardiometabolic scenarios.
Proactive Action
Google Cloud Functions trigger Salesforce CRM lead objects for enrollment marketers. Agents view patient info, trigger reasons, and health history—then schedule appointments and update disposition status.
Efficacy Tracking
All patient updates, new claims, and CRM task dispositions flow back to executive dashboards. Program stats, trigger reasons, objection reasons, and cost projections are tracked in real time.
Role-specific views that drive decision-making
The platform delivers three distinct dashboard experiences tailored to C-level management, enrollment marketers, and physicians. Each view provides actionable data specific to the user's workflow, from high-level cost forecasting to individual patient health histories.
C-Level Executive Dashboard
The executive dashboard provides a comprehensive view of total patient spending ($63.7M tracked), cardiometabolic spending ($8.5M), and potential savings ($109K+ identified). Interactive charts break down spending by quarter, comparing enrolled vs. non-enrolled patient costs.
Average spending for enrolled patients was $14,326 compared to $23,693 for non-enrolled patients—demonstrating clear cost savings from the intervention program and providing executives with the transparency needed to justify program investment.
Enrollment Marketer Dashboard
The marketer dashboard tracks enrollment rates, volume contacted timelines, primary trigger reasons, and top objection reasons. With 7,020 enrolled patients and a 58.84% overall enrollment rate, marketers can optimize outreach strategies in real time.
Active leads, disposition status breakdowns, and trigger-by-reason analysis are all visible at a glance. The dashboard tracks 950 active triggers with a 62.27% close ratio, enabling data-driven refinement of the enrollment process.
Patient At-a-Glance View
The physician-facing view provides a comprehensive patient profile with contact information, trigger reasons (e.g., “diabetic with visit in 6 months,” “diabetic with A1C in 12 months”), criticality levels, and a complete visit history.
An interactive visits chart visualizes healthcare utilization by month and place of service—ambulance, ASC, emergency, inpatient, office, and outpatient—giving physicians immediate context before any patient interaction.
Seamless Salesforce workflow for telehealth agents
One of the platform's key differentiators is its direct integration with the telehealth provider's Salesforce CRM. Rather than requiring agents to check a separate analytics portal, intervention triggers are delivered as actionable tasks within their existing workflow.
Task List & Lead Management
Agents log into their familiar Salesforce Provider Dashboard to find newly created lead objects. Each lead represents a patient identified by the rules engine as needing intervention. No additional SSO steps or separate applications required.
The agent can select an opportunity task, view patient details, make outreach calls, schedule telehealth appointments, and update the disposition status—all within Salesforce. This closed-loop workflow ensures every intervention is tracked back to the executive dashboard.
Patient Detail & Health History
When an agent selects a patient lead, they see comprehensive detail including trigger reasons with criticality levels, recent health history with diagnosis codes and procedure descriptions, and a visual timeline of visits by place of service.
This integration means the agent arrives at every patient call armed with full context: why the system flagged this patient, their recent medical encounters, and what type of intervention is recommended. The result is more informed conversations and higher enrollment rates.
HIPAA-compliant cloud architecture built for scale
Every component of the Congruity Analytics platform was architected with HIPAA compliance as a foundational requirement. The solution architecture team evaluated multiple options for each pipeline stage—comparing managed vs. self-hosted services, single-cloud vs. multi-cloud deployments, and build vs. buy trade-offs through structured comparison matrices.
Key architectural decisions included selecting a managed FTPS service over self-hosted options for reduced operational overhead, choosing a serverless data warehouse for cost-effective scaling, evaluating hosted vs. embedded BI platforms for role-specific dashboard delivery, and designing the rules engine to evolve from SQL-based logic to machine learning models as data volume grows.
Managed FTPS Service
Selected a managed FTPS service over self-hosted alternatives after evaluating operational overhead, security posture, and HIPAA compliance. Client-specific endpoints with custom identity provider configuration.
Multi-Cloud Pipeline
Evaluated multiple cloud storage and data warehouse options across cost, query performance, and ML integration capabilities. Selected a multi-cloud approach combining encrypted object storage with a serverless data warehouse.
SQL → ML Evolution Path
Designed the rules engine to start with SQL-based trigger logic for the MVP, with a clear evolution path to machine learning models as data volume and pattern complexity grow. Serverless functions handle trigger execution.
Salesforce
Automated lead object creation for enrollment marketers. Bi-directional sync returns CRM task disposition status back to the data warehouse for efficacy tracking and conversion analytics.
BI Platform
Evaluated hosted BI platforms, embedded analytics, and custom-built dashboards. Selected a cloud-hosted approach that balances enterprise capability with cost-effective scaling for role-specific views.
Multi-Tenant Architecture
Designed from day one to onboard new clients efficiently. Each client receives isolated data pipelines and customized dashboards, with a reusable architecture that minimizes per-client setup time.
Competitive research that shaped product strategy
The competitive analysis delivered actionable insights across six strategic dimensions, directly informing the platform's differentiation strategy and product roadmap. Each insight translated into specific product decisions.
Self-Funded Employer Focus
No competitor specialized in self-funded employer plans. This became Congruity's primary differentiator: customize workflows for self-funded plans and market directly to employers and TPAs.
Actionable AI-Driven Data
Everyone claims AI-driven data, but few make it actionable. Congruity's approach: establish automated intervention flows with tangible communication plans, not just recommendations the employer must act on.
Telehealth Integration Gap
Only Inovalon and Innovaccer offered true telehealth components. Congruity closed the gap between data, savings, interventions, and actually reaching the patient through connected outreach.
Employer Transparency
Few competitors showed employers exactly how interventions save money. The platform provides monthly data on agent activities, cost savings, and health interventions through easy-to-customize dashboards.
Chronic Care Frameworks
The analysis recommended focusing on one or two high-cost conditions initially—diabetes and cardiometabolic disease—before expanding to broader preventative care frameworks.
Market Positioning
Competitors like Innovaccer and Health Catalyst were valued at over $1 billion. The research identified a clear roadmap for Congruity to position for growth through differentiated features and investor-focused dashboards.
From urgent care visit to improved health outcomes
The platform transforms the patient journey from reactive emergency care to proactive health management. Here is a typical scenario demonstrating the end-to-end value chain.
Urgent Care Visit
John Doe visits urgent care. Claims data is ingested into the platform through the TPA's data feed.
Trigger Fires
3 months pass without a follow-up PCP visit. The rules engine triggers an intervention opportunity and creates a CRM lead for the telehealth agent.
Telehealth Visit
The agent reaches out, schedules an appointment, and John Doe attends a telehealth visit addressing his health needs proactively.
Health Improvement
3 months later, follow-up results show improvement. The patient drops from the high-risk group, reducing future cost projections.
Future State Journey Map
Digital Scientists created both current state and future state journey maps to visualize the patient experience with and without the Congruity Analytics platform. The future state map shows how telehealth, employer, and physician touchpoints are connected through the analytics platform.
Data-driven interventions that reduce cost and improve care
The Congruity Health platform is set up to proactively and predictively target patients in need of care by increasing access and accountability for targeted chronic disease management. The result: more accountability in healthcare and visibility to data that can reveal a patient's changing health status based on the level of care they receive.
Working toward a mutual goal, Congruity Health and Digital Scientists are empowering the consumer while helping to decrease major health events and their associated costs.
Enrolled patient average spending of $14,326 vs. $23,693 for non-enrolled—a 39% cost reduction demonstrating intervention program efficacy
58.84% patient enrollment rate with 326 patients contacted monthly, driven by data-informed agent outreach and clear trigger reasons
$109,508 in cardiometabolic savings identified through the predictive analytics pipeline, with ongoing quarterly cost tracking
Seamless CRM integration eliminated separate analytics portals, putting intervention data directly in telehealth agents' Salesforce workflow
Clear competitive differentiation established in self-funded employer plans with integrated telehealth—a combination no competitor offered
340
New Patients / Month
203
Generated Leads / Month
62.27%
Trigger Close Ratio
950
Active Triggers
$63.7M
Total Patient Spending Tracked
What we delivered
Research & Strategy
- Alignment workshop & vision report
- Blue Ocean competitive analysis (7 competitors, 8 dimensions)
- Stakeholder & competitor mapping
- User interviews & persona validation
- Current & future state journey maps
Data & Analytics
- HIPAA-compliant data pipeline (FTPS → S3 → BigQuery)
- Proprietary rules engine & ML trigger logic
- Data flow diagrams & documentation
- Initial trigger details & dashboard data points
- Solution architecture document with technology comparison matrices
- Multi-cloud architecture recommendation (AWS + GCP)
Platform & Integration
- Tableau dashboards (C-level, enrollment marketer, physician)
- Salesforce CRM integration (bi-directional)
- Patient-at-a-glance views for physicians
- Agent task & lead management workflow
- Mock & live data testing (AWS S3, BigQuery, Stitch)
“The team at Digital Scientists was a huge help in not only developing our analytics platform, but understanding the competitive space and defining our true value proposition for our customers.”
Justin Davis
CEO, Congruity Health
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