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.
One Solution – Multiple Populations
Identify, assess and track the risk of attributed members in MSSP or Next Gen models for performance measurement and benchmarking.
Engage with our risk adjustment experts to develop the optimal strategy for your Medicaid offering.
Our end-to-end solution enables you to close data gaps, optimize risk capture, and better manage your risk adjustment strategy.
Download Solution Capabilities Matrix
- Continuous improvement by utilizing machine learning
- Highest sensitivity and specificity in the industry
- Extraction of valuable insights from clinical notes to identify risk factor
- Ingestion of all structured and unstructured data, either as images or electronic documentation
- HL7/CCDA/flat file EHR integration
- High accuracy Optical Character Recognition (OCR) for scanned documents
- Secure remote print of medical charts
- Automatic identification of documented conditions that were previously not reported
- Claims linking to accepted codes as part of the workflow
- Embedded ICD-10 look-up tool
- Coding workbench with intuitive workflow for coders
- Identify incremental opportunity by applying NLP to unstructured clinical charts in addition to medical and pharmacy claims
- Improve financial results by uncovering suspects for prospective risk capture
- Create prospective campaigns from intuitive reports and visualizations
- Discover new insights into RAF opportunity and capture rates throughout the provider network to drive key process improvements
- Built-in quality assurance, audit trail and validation tools
- Support for RADV audits
- Identification and removal of unsupported risk factors
- RAPS/EDPS ready submissions
- Executive dashboards and KPIs for managing risk adjustment programs
- Multi-dimensional analysis, prioritization and filtering of prospective opportunity
- Ad-hoc reporting
- Delivery of targeted suspected conditions to physicians
- Point-of-care integration with electronic health records
- Continuous engagement and integration into care efforts
- Measurement and profiling for provider selection, training, and oversight
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.
Identify and document areas for risk adjustment optimization
Develop a business case and strategic roadmap for risk adjustment optimization
Evaluate network partners based on readiness to contribute to the optimization effort
Implement the Health Fidelity solution based on strategic roadmap and readiness evaluation
Utilize insightful reports and dashboards to monitor the impact to the business