Solutions

It’s a Matter of Vision

Health plans are making risk adjustment decisions using just 20% to 30% of available medical data which inevitably leads to inaccurate coding and unidentified risk.

Get a 360-Degree View

Provide your risk adjustment team with access to all available information – including previously unavailable clinical data – in a comprehensive workflow for complete risk identification.

Transform Risk Adjustment

With coordinated retrospective and prospective analyses, workflow optimization, and point-of-care integration your team will have the requisite amount of control, transparency, and information required to successfully run your plan’s risk adjustment program.

Visible Results

  • Discover all documented conditions
  • Capture risk accurately
  • Increase coder productivity by 4x
  • Identify suspected conditions
  • Address RADV audit risks

Experience Transparency

Traditional risk adjustment as it’s always been done is no longer viable; going forward, organizations must operate with a full 360–Degree View of risk adjustment to project, detect, and capture all commensurate member risk.

One Solution – Multiple Populations

Medicare Advantage

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Capture all undiscovered risk and compliance issues to optimize financial and operational performance.

View Solution Brief

Commercial ACA

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Optimize resource utilization and capture undiscovered risk to ensure transfer payments commensurate to population risk.

View Solution Brief

Medicare ACO

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Identify, assess and track the risk of attributed members in MSSP or Next Gen models for performance measurement and benchmarking.

Medicaid

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Engage with our risk adjustment experts to develop the optimal strategy for your Medicaid offering.

The Health Fidelity Approach

We use our proven model to understand the key business characteristics of our clients, identify and assess the opportunity for risk optimization, determine network readiness, and finally implement our solution to measure the improvement and delivered ROI.

HF360 Blueprint

1

Discovery & Data Collection

Review current processes


Evaluate current
state


Compilation of all current activities and processes

2

Financial Opportunity

Search for revenue opportunity


Analyze historical
data


Financial opportunities

3

Clinical Data Landscape

Document data availability


Discuss chart retrieval efforts/vendors


Inventory of all data sources

4

Network Readiness

Understand organization readiness


Reflect on internal readiness


Gaps in organizational alignment

5

360º
Blueprint

Develop your HF360 Blueprint


Identify methods of improvement


Roadmap to improvement

Connect with us to schedule a demo or get a customized assessment and action plan to transform your risk adjustment program. Contact us to get started.