Care management
OVERVIEW
A prospective formula for success
Our end-to-end prospective Risk Adjustment solutions are the most comprehensive in the industry. The Provider Engagement program encourages and strengthens the relationship between a patient and their physician while supporting providers with one seamless process. The key to this program’s success is the delivery of actionable data for all members at the point of care – where it matters most. Certified coder teams provide a technology-enabled review, and submissions complete the cycle
OFFERINGS
Evidence-based insights that impact outcomes
Help providers close HCC and HEDIS® gaps and improve documentation with user-friendly initiatives that fit into their existing workflows. Concurrent reviews of Clinical Documentation Improvement (CDI) Alerts address discrepancies and accurately and compliantly close gaps
Service
On-site Provider Engagement
On-site services bring our expert staff into provider office workflows
Service
On-site Provider Engagement
On-site services bring our expert staff into provider office workflows
Service
Electronic Provider Engagement
Enables providers with electronic methods for documentation improvement opportunities
Service
Electronic Provider Engagement
Electronic alerts are delivered at the point of care through providers’ existing electronic medical records system or web-based portal
Service
Remote Provider Engagement
Leverage other options for CDI Alert delivery
Service
Remote Provider Engagement
Enables providers in remote areas or with limited electronic medical record capabilities
Service
Encounter Data Submissions
Successful, compliant submissions
Service
Encounter Data Submissions
Successful, compliant, and reliable data submissions to CMS
BENEFITS
Boost results with proven, strategic programs
OUTCOMES
Outcomes that make an impact
Results don’t just stop at better Risk Adjustment and provider-friendly technology. Improving access and follow-through with preventive care and HEDIS® measures are key levers for increased performance
5%
Average HEDIS® Measure Improvement
5:1
ROI Program Average
10-15%
Average improvement
Let’s unburden your health plan today
Reach out to discover how our innovative solutions can help unburden your plan and streamline operations. Together, we’ll elevate your business to new heights
SOLUTION GROUPS
Featured Risk Adjustment solutions
HEDIS®
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)