Resource Library


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.

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.

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.

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.

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.

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.

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.

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.


Go inside the Health Fidelity NLP engine in this animated short that reveals the science and art of this innovative technology. Learn how risk adjustment activities in particular can benefit from this data enhancing approach.

In this webinar, learn how UPMC employed a technology-enabled risk capture strategy to help providers succeed in risk-based payment models without further contributing to burnout.

Today, the use of technology to generate analytics and direct operational resources is the minimum automation required for payers to compete in a world of increasing data, growing memberships, and intricate provider networks. Hear how Chinese Community Health Plan (CCHP) has leveraged technology over the past two years to improve their risk adjustment performance.

Join Anand Shroff as he debunks common misconceptions about NLP. Learn how you can differentiate and evaluate NLP engines, and find out how other organizations are leveraging NLP to improve their clinical, financial, and operational outcomes.

Health plans and providers in risk-sharing arrangements are equally responsible for risk adjustment and quality outcomes, and not just at the integrated delivery system level. To be successful, they must build a strong working relationship. Find out how UPMC achieved this collaboration and hear their results.

Join Anand Shroff, Health Fidelity Founder, as he relays the experience of three clients who successfully adopted the 360° view methodology to overcome financial, compliance, and capacity challenges.

Medical record retrieval is commonly cited as a top pain point, but new data acquisition technology may change the way you feel. In this webinar, hear how you can leverage this innovation, and how other organizations have reduced their chart retrieval costs while improving their risk adjustment ROI.

Discover why an integrated, comprehensive risk adjustment framework is required to address the ongoing financial, patient care, and competitive challenges facing risk-bearing entities in the era of value-based care and learn how you can adopt this methodology for your organization.

With the mandate to “do more with less,” Providence Health Plan turned to Natural Language Processing (NLP) technology to address their risk adjustment challenges. In October, Providence Director of Coding Compliance – Rebecca Welling – shared how her decision to equip her coding team with access to all available information via NLP allowed for better efficiency, increased risk capture, and reduced audit risk.

Case Studies

In 2014, UPMC Health Plan, as part of a leadership-sponsored strategic initiative, implemented Lumanent Retrospective Review 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.

Papers & Reports

The post- encounter process is often the ideal starting place for organizations new to risk adjustment. It enables the capture of risk that has already been documented but not coded. Learn more about the process in this white paper.

A key focus area required for value-based care success is setting up a comprehensive risk capture strategy, in which organizations need to accurately identify, document, and report the known risk conditions of each patient in order to receive commensurate reimbursements. Discover how organizations like Mount Sinai Health Partners who use a risk capture maturity model to plan out their improvement path forward are seeing better outcomes in this white paper.

In April 2016, KLAS Research interviewed academic facilities, large IDNs, and known NLP users to provide an overview of the NLP market, provider strategies, and NLP use cases currently in practice. Request a copy of the report excerpt to learn how current users rated our solution, HF REVEAL.

Solution Briefs

The first comprehensive solution that combines analytics, technology, services, and subject matter expertise to help providers succeed in risk-sharing programs.

Lumanent Payer Workflow is a comprehensive, end-to-end solution suite to acquire, analyze, and submit risk adjustment data

A sophisticated healthcare NLP engine, trained and refined with millions of actual patient data, that provides the greatest depth and breadth of industry standard terminology support.

Discover our flexible suite of technology and services that can be tailored to maximize retrieval of medical records and other patient data.

Learn about Health Fidelity’s proven methodology to discover and quantify your risk adjustment potential with a customized benchmark for your organization.

Data Sheets

Health Fidelity’s Lumanent™ provider workflow is a technology-enabled solution that leverages natural language processing (NLP) to simplify the risk capture process for risk-bearing providers.

Health Fidelity’s automated retrospective risk adjustment solution, which provides technology and workflow enhancements for coding organizations to optimize risk capture.

Health Fidelity’s prospective risk adjustment solution, which provides advanced analytics to identify suspected conditions in order to optimize risk capture.