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

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.

Solution Capabilities

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

id_nlp

  • Continuous improvement by utilizing machine learning
  • Highest sensitivity and specificity in the industry
  • Extraction of valuable insights from clinical notes to identify risk factor

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  • 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

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  • 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

id_prospective

  • 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

id_compliancesupport

  • Built-in quality assurance, audit trail and validation tools
  • Support for RADV audits
  • Identification and removal of unsupported risk factors
  • RAPS/EDPS ready submissions

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  • Executive dashboards and KPIs for managing risk adjustment programs
  • Multi-dimensional analysis, prioritization and filtering of prospective opportunity
  • Ad-hoc reporting

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  • 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.

View Solution Brief

1

Discovery

Identify and document areas for risk adjustment optimization

2

Opportunity

Develop a business case and strategic roadmap for risk adjustment optimization

3

Readiness

Evaluate network partners based on readiness to contribute to the optimization effort

4

Implementation

Implement the Health Fidelity solution based on strategic roadmap and readiness evaluation

5

Measurement

Utilize insightful reports and dashboards to monitor the impact to the business

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.