SCIO Health Analytics Signs 6 New Reimbursement Optimization Clients with Focus on Quality and Risk Adjustment in First Half of 2016

WEST HARTFORD, Conn., Oct. 4, 2016 /PRNewswire/ -- SCIO Health Analytics today announced that it added four new clients to its reimbursement optimization line of business in the first half of 2016. In addition, the company expanded its engagement with two existing provider clients.

Of the six wins, two involve helping organizations optimize revenue as they make the transition from traditional fee for service (FFS) to value-based care, which is an ongoing challenge for many organizations. The other four are focused on analytics that ensure organizations are performing the appropriate services and documenting them properly to set risk adjustment levels for Medicare Advantage plans. This is key to aligning risk-adjusted reimbursement with the level of care delivered. It also makes it easier to report those services as they are performed rather than waiting months to receive a reduced payment. The new client wins span the gamut of Medicare, Medicaid and commercial businesses.

Moving from FFS to value-based care is proving challenging for payers and providers. Where once more care was better (and more profitable), the goal now is to deliver the highest level of quality in the lowest-cost appropriate setting to ensure better outcomes at a lower cost. SCIO delivers advanced predictive analytics that incorporate deep knowledge of industry coding rules, risk adjustment, quality measures and regulations as well as clinical and claims review expertise. Payers benefit by discovering weaknesses in their systems, data flow and processes that contribute to errors that must be caught and corrected later. Providers benefit by reducing denials and speeding the revenue cycle while ensuring they meet all regulatory requirements.

SCIO's analytics also help providers manage their Medicare Advantage populations more effectively by showing where care gaps are so providers can deliver and document the services required for risk adjusted reimbursement. They provide actionable information in identifying and managing patient populations and their related risk adjustment factor (RAF) scores, thus driving revenue from payers according to standards set by the Centers for Medicare and Medicaid Services (CMS).

"The changes occurring in the healthcare industry right now are creating profound challenges for payers and providers of all sizes," said Krishna Kottapalli, chief growth officer and co-founder at SCIO Health Analytics. "In order to maintain or boost revenue in the coming years they must ensure they're doing the right things at the right time and in the right way. SCIO's reimbursement optimization solution delivers the payment integrity, risk adjustment and quality measurement capabilities that impact success today as well as going forward. We are gratified that these new and expanded clients have chosen to make SCIO their partner in this journey."

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About SCIO Health Analytics

Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company. It serves healthcare organizations across the continuum including over 20 provider groups and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30 countries for 8 of the top 15 global pharmaceutical companies. SCIO provides predictive analytic solutions and services that transform data into actionable insights, helping healthcare organizations create the understanding that drives change through care, network and reimbursement optimization as well as commercial effectiveness. SCIO's insights as a service approach supports the shift to value-based care, solving healthcare problems simply and efficiently. Visit SCIO's new website for up to date information on their product and solution offerings: www.sciohealthanalytics.com

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