Risk adjustment opportunities
Health Fidelity's Risk Analytics solution helps organizations identify prospective risk adjustment opportunities in the form of suspected conditions that are neither documented nor submitted to governing entities. Its suite of reports and visualizations provides actionable insights that help inform prospective campaign strategies to optimize ROI. It is the only analytics solution available in the market that generates suspected conditions from unstructured clinical data in medical records by applying industry-leading natural language processing (NLP) technology. This technology identifies incremental opportunity that would otherwise be missed due to incompleteness or inaccuracy in claims data.
New ACA capabilities
Using Risk Analytics, ACA plans will be able to better target prospective risk adjustment initiatives by stratifying opportunities in metal levels and age groups. Furthermore, plans will now have the ability to estimate the potential impact to transfer payments based on outstanding suspected conditions. Using customizable values that affect transfer payment estimates specific to each market, such as plan- and state-specific factors, plans will have better visibility into how their initiatives are impacting transfer payments.
"ACA plans need to ensure now that they have a solid risk adjustment strategy going into 2017," said Whitehurst. "Setting up a comprehensive platform like Risk Analytics in 2016 will help organizations be prepared for when the safety net of reinsurance and risk corridors is no longer available."
Risk Analytics for ACA, Medicare Advantage, and Medicare ACO is available now. To learn more, visit www.healthfidelity.com.
About Health Fidelity
Health Fidelity delivers innovative solutions for the value-based care era. Using groundbreaking NLP and analytics technology, Health Fidelity's risk adjustment solution is changing the way risk is identified, quantified and managed for organizations that participate in Medicare Advantage, ACA, Medicaid, and Medicare ACO programs.
Health Fidelity is a registered trademark of Health Fidelity, Inc.
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SOURCE Health Fidelity