Transform Healthcare for Better VBC Outcomes with Our Innovative Risk Data Analytics Solutions
Our platform is designed to empower healthcare organizations to thrive in this value-driven healthcare landscape, leveraging advanced risk analytics and comprehensive tools that streamline both Risk Adjustment and Clinical Documentation Improvement (CDI) processes. Our platform is built on a Risk Adjustment Factor (RAF) Engine, which calculates patient-level risk scores, supports Hierarchical Condition Categories (HCCs) coding, effectively manages CDI, and provides actionable insights to proactively manage patient populations.
By focusing on value over volume, healthcare organizations can:
- Improve patient outcomes and satisfaction.
- Reduce unnecessary hospitalizations and costly procedures.
- Maximize financial performance through optimized reimbursements.
Explore Our Toolkit and Platform for Advanced Value-Based Care Solutions
With the combination of powerful products and versatile tools, our toolkit offers healthcare providers a complete solution for navigating the complexities of value-based care. Our tools include:
RAF Score Analysis
Calculate a comprehensive Composite RAF Score to assess patient risk levels across multiple conditions. This tool helps healthcare providers identify care gaps in high-risk conditions like diabetes or heart failure, enabling more focused interventions. By enhancing clinical documentation, organizations can improve care outcomes, ensuring accurate patient risk stratification. Additionally, optimizing RAF scores supports fair reimbursement under value-based care models, maximizing financial performance.
RAF Score REST API
Integrate real-time risk scoring seamlessly into your healthcare systems with our advanced RAF Score REST API. This API enables instant and precise RAF score calculations, allowing healthcare providers to access prioritized actionable care insights at the point of care. With its focus on real-time scoring, providers can identify high-risk patients quickly, ensuring timely interventions and improving patient care quality. The API is designed to reduce administrative burden while enhancing both care delivery and financial outcomes.
RAF Batch Scoring
Automate large-scale RAF score calculations across vast patient datasets with our RAF Batch Scoring solution. This tool streamlines bulk data analysis, allowing healthcare organizations to process multiple patients' risk scores simultaneously, saving time and improving operational efficiency. By simplifying the risk adjustment process, RAF Batch Scoring ensures consistent accuracy, helping healthcare providers better manage risk stratification for large patient populations and optimize reimbursement strategies.
VBC Risk Analytics Platform
Leverage our VBC Risk Analytics Platform to automate the RAF scoring process across multiple patients, streamlining data analysis and improving overall efficiency. This platform supports value-based care by providing actionable insights that help healthcare organizations prioritize interventions for high-risk patients. With its ability to process bulk data at scale, the platform significantly reduces manual effort, enhances care coordination, and optimizes financial performance through accurate risk adjustment.
Key Use Cases
- Analyze patient data current financial year E & M claims data with past 1-3 Financial year E & M claims data to understand risk levels and risk gaps, enabling the selection of high-risk patients for more targeted care and HCC audits.
- Real-time Patient Risk Stratifications using risk score (riskiest population and configurable low, med, and high population), HCC count, or Disease Interactions, for various Risk Adjustment Programs or Initiatives.
- Analyze prospective reviewed disease conditions with the risk score and revenue impact for supported and unsupported conditions and prioritize high-risk unsupported conditions that require the most attention in care and clinical documentation.
- Analyze concurrent reviewed disease conditions with add, delete, no change, modified from and modified to flags every month in provider, specialty, and clinic level, and get the revenue and RAF impact insights and priorities the high risk and revenue impact ICDs/HCCs for CDI, reducing physician CDI burden.
- Leverage risk score analytics to strategize value-based care, measure patient outcomes, and optimize reimbursements
- Before acquiring a practice, evaluate patient populations to assess Medicare over-payment or under-payment risks based on risk scores to make informed M & A decisions
Benefits of Using Our Risk Score Based Value-Based Care Solutions
Our risk analytics platform enables providers to plan, measure, and continuously monitor in the same way how they are reimbursed, and it seamlessly sits in the risk adjustment and CDI workflows.
Enhanced Patient Care
Our platform empowers healthcare providers with data-driven insights to prioritize high-risk patients and identify care gaps effectively. By utilizing precise risk stratification, providers can focus on those patients who need urgent care, improving both immediate and long-term health outcomes. With real-time analytics, clinicians can make informed decisions at the point of care, ensuring that patient needs are addressed promptly.
Optimized Reimbursements
Accurate RAF scoring and Hierarchical Condition Category (HCC) coding are vital to capturing complete patient information, and our solution ensures this process is seamless. By documenting chronic conditions and complications accurately, healthcare providers can secure higher reimbursements for treating high-risk populations. Our platform simplifies coding complexities, reducing the likelihood of errors and missed opportunities.
Streamlined CDI Process
Our integrated Clinical Documentation Improvement (CDI) risk analytics platform helps clinicians identify and prioritize high-risk documentation gaps quickly. With targeted feedback loops, physicians can improve the accuracy and specificity of their documentation, leading to better coding and patient care. The platform automates much of the CDI process, freeing up clinicians' time and allowing them to focus on patient interactions.
Reduced Physician Burnout
Long lists of disease conditions at the point of care can overwhelm physicians, leading to burnout and decision fatigue. Our platform alleviates this burden by prioritizing high-risk disease conditions for physicians, helping them focus on the most critical cases first. By providing actionable insights, the platform helps physicians streamline their workflows, and improving their capacity to deliver patient-centered care.