Solutions – Payer

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.

(eBook 1)

Introduction

In this paper, Health Fidelity outlines the concept of a 360-Degree View of Risk Adjustment and articulates why it’s vital to succeed in today’s value-driven care environment. Additionally, organization’s can also learn the evaluation framework required to assess your readiness to adopt the 360-Degree View. More Info

(eBook 2)

Organizational Alignment

In order to make downstream risk adjustment modernization efforts as effective as possible, organizations need to ensure they have the appropriate structure, goals, and incentives in place. In this next chapter, Health Fidelity examines the operational infrastructure and leadership activities required to set a foundation for performance improvements. More Info

(eBook 3)

Data & Performance Management

In the third installment, Health Fidelity assesses accessibility to data – clinical, claims, and beyond – along with performance transparency; both are critical components required to achieve a culture of continuous improvement across the organization. More Info

(eBook 4)

Prospective Review

With operational precursors complete, this paper turns to core risk adjustment activities, beginning with prospective review. Coordinated efforts in provider engagement, member outreach, and data-driven prioritization will be key to optimizing prospective review results. More Info

(eBook 5)

Provider Engagement

Providers are key partners for many payer-led initiatives, including but not limited to risk adjustment. In order to enhance both quality of care and financial outcomes, organizations should make sure the appropriate alignment, incentives, education, and tools are in place to increase providers’ engagement with these initiatives. More Info

(eBook 6)

Data Acquisition

Organizations should enable access to the fullest breadth of up-to-date clinical data from medical records. Many areas within the organization will benefit from increased access to data – not just risk adjustment. The key is to invest in scalable solutions that enable multiple departments to leverage a common set of records and reduce redundant chart retrievals that are extremely costly. More Info

(eBook 7)

Retrospective Review

In this paper, Health Fidelity reviews technology-enabled workflows that allow risk conditions to be captured more accurately and efficiently. When many of the tedious manual processes are augmented with technology, coders can better utilize their skills to focus on accurate coding of diagnoses. More Info

(eBook 8)

Compliance

In the final installment, Health Fidelity presents modern approaches to compliance that ensure maximal adherence to regulations and protect against possible penalties. Small enhancements with risk adjustment processes can help to ensure proper validation of codes and better audit preparedness. More Info

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.