One of the Country’s Largest and Most Innovative Health Systems Deploys Technology Solution, Comes on Board as Investor
UPMC identified the value of using a comprehensive risk adjustment solution for Medicare Advantage, Medicare ACO and health insurance exchange programs and then partnered in 2014 with Health Fidelity to complete development of this technology. The Health Fidelity risk adjustment solution, deployed at UPMC Health Plan last year, significantly enhances operational efficiency and compliance management. With UPMC’s strategic investment in the company, Health Fidelity is accelerating the introduction of risk adjustment and other value-based care solutions to the market.
As the healthcare ecosystem shifts from a fee-for-service to a value-based business model, healthcare organizations are looking for ways to optimize risk adjustment operations and improve compliance. Health Fidelity helps integrated delivery systems, health plans and health systems perfect the risk adjustment cycle by applying technologies that improve and complement existing systems and processes. Today, most of these organizations are making population management decisions using only 20% to 30% of available clinical information because of the challenges involved in interpreting and applying unstructured data. Health Fidelity provides solutions that leverage previously untapped data, which empowers organizations to streamline revenue operations, achieve higher levels of compliance and realize greater efficiencies.
“By collaborating with the clinical and technology experts at UPMC, Health Fidelity is able to offer the most comprehensive, scalable solution on the market for perfecting the risk adjustment cycle,” said Mary Beth Jenkins, Senior Vice President and Chief Operating Officer, UPMC Health Plan and UPMC WorkPartners. “It’s an innovative technology that has delivered measurable results to UPMC Health Plan, seamlessly integrating with existing risk adjustment processes to deliver results while improving compliance and process efficiencies.”
The simplicity of Health Fidelity’s solution is especially attractive to organizations that are looking to reduce the complexity of risk adjustment operations. The solution is designed to efficiently enhance retrospective and prospective analyses with an intuitive workflow that integrates disparate tasks into more streamlined, collaborative processes. Using cutting-edge natural language processing (NLP) technology, the solution maximizes client value by continuously improving the risk adjustment cycle.
UPMC, a national leader in the innovative use of technology, evaluated options and selected Health Fidelity as a partner due to its expertise in NLP and analytics. UPMC is now collaborating with Health Fidelity to innovate on additional use cases that will improve healthcare delivery and population management.
Health Fidelity plans to use the cash infusion to expand research and development, strengthen its team and increase the company’s market share. Health Fidelity will assess potential partnerships with additional investors, integrated delivery systems, health plans and health systems at the upcoming RISE Conference. To learn more about Health Fidelity and its groundbreaking value-based care solutions, please visit www.healthfidelity.com.
A world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of accountable, cost-effective, patient-centered care. It provides more than $887 million a year in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution. The largest nongovernmental employer in Pennsylvania, UPMC integrates more than 60,000 employees, more than 20 hospitals, more than 500 doctors’ offices and outpatient sites, a more than 2.5-million-member health insurance division, and international and commercial operations. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC ranks No. 12 in the prestigious U.S. News & World Report annual Honor Roll of America’s Best Hospitals — and No. 1 in Pennsylvania. For more information, go to UPMC.com.