Health Plans

Insights to improve risk adjustment, quality, and population health

RISK ADJUSTMENT

Accurate risk scores & payments

QUALITY

Improve quality & boost ratings

POPULATION HEALTH

Optimize outcomes & reduce utilization

Risk Adjustment

  • No SAS® required CMS-HCC models
  • Integrate CMS-HCC models into ETL
  • Ensure complete & accurate payments
  • AI-powered HCC code identification
  • Identify opportunities for improvement with and without medical record review
  • Identify and manage prospective gaps in care
  • Prioritize outreach with proven AI and machine learning adherence models
  • Medicare Advantage Star Ratings, ACA Quality Ratings System, and other quality measurement systems
  • Improve patient experience measure performance (CAHPS / HOS)

Quality

Population Health

  • Identify and stratify by member cohort and risk
  • Predict future outcomes, utilization, and costs
  • Engage members for care coordination and intervention
  • Analyze physician practice to improve quality and reduce costs
  • Monitor and evaluate programs to determine success, learn, and improve

Health Plan Offerings

Improve your health plan risk, quality, and population health performance