Health Plan Solutions

A New Approach to Risk for a New Era of Healthcare

Surviving today’s environment as an insurer feels a bit like trying to escape from a pressure cooker. Between regulatory uncertainty, increasing amounts of patient data, industry consolidation, and an aging population, health plans are being pulled to the breaking point by numerous factors.

Healthy Fidelity’s NLP-enabled risk adjustment solution offers insurers a complete and holistic view cutting across all risk adjustment activities to usher in the next generation of risk determination. Break free from the operational constraints to better project, detect, and capture the true risk of your membership.

Transform Risk-Adjustment Operations
with our NLP-Enabled Coding Solution to:

1

Improve Accuracy

HCC Scout empowers coders with a clean and prioritized queue to complete two-way records review for evidence-derived up-side and down-side retrospective coding. Included “Manager Mode” provides QA capabilities to ensure that your submission is both complete and accurate.

2

Lower Coding Costs

After our NLP weeds out the roughly 40-50% of records without opportunities, HCC Scout directs coders to only those records requiring a manual review; highlighting the relevant sections of the chart containing the evidence and reducing the time required to identify additional codes to be captured.

3

Better Harness Information

HCC Scout provides coders with a consolidated view of all available records for a member so coders have the most complete context of the patient’s health status when coding.

4

Effortlessly Scale Across Populations

Our solution works across and understands the nuances of risk-adjusted claims reimbursement for different member populations. Transform an otherwise manual and disparate risk adjustment process into an integrated workflow across Medicare Advantage, ACA Commercial, Managed Medicaid, or Medicare ACO programs.

How to Get There

With Health Fidelity, complete and accurate risk capture is attainable with our modular application suite, customizable to your specific needs and readiness:

Data Acquisition

 Lower the cost and hassle of chart retrieval and medical records management and supply the NLP with the broadest set of documentation available via our Automated Chart Extraction tool.

Learn More: ACE »

Clinical Suspecting

Improve risk score accuracy and enable providers to close diagnosis gaps on suspected conditions with Risk Analytics.

Learn More: Risk Analytics »

Retrospective

With HCC Scout, improve the productivity and efficiency of your internal coding staff to manage first or second pass reviews.

Learn More: HCC Scout »

Consolidated Client Outcomes

4X

Increase in Coder Productivity

20-30%

Increase in Risk Capture

40%

Decrease in Costs

UPMC-logo

Partner Spotlight: UPMC

In 2014, UPMC Health Plan, as part of a leadership-sponsored strategic initiative, implemented HCC Scout to help increase accurate RAF capture in compliance with CMS Risk Adjustment guidelines while improving overall coding efficiency.

The health plan, which was already running sophisticated risk adjustment operations, saw a remarkable return on investment with a study conducted on PY2012 members.

“HCC Scout completely transforms the process of risk adjustment through its intuitive workflow. By consolidating all essential data points into one managed workflow, we can ensure efficiency, compliance, and accurate and optimal risk capture, affording us the opportunity to spend more time focusing on the quality of care provided to our membership.”

– Mary Beth Jenkins, SVP & COO, UPMC Health Plan

Related Resources

Blueprint to 360° Risk Adjustment

Health Fidelity’s proven methodology allows you to discover and quantify your risk adjustment potential.

Learn More

AHIP Webinar: Providence Health Plan’s 360º Approach to Risk Adjustment

Providence leveraged NLP technology to address risk adjustment challenges, resulting in better efficiency, increased risk capture and reduced audit risk.

Learn More

Blog: How Technology Can Help Ensure the Utmost Compliance in Your Risk Adjustment

Teresa Ross discusses the buzz around compliance in risk adjustment.

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Change Healthcare Leverages HF Coding Platform

This collaboration gives payers more than one route to adopting an NLP-enabled risk adjustment approach that offers enhanced performance, outcomes, and reimbursements.

Learn More

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