Stop the Health plans from being the referee and scorekeeper

50% of all healthcare spending should be in value-based payments by 2025, per CMS.

Organizations need to understand the impact of not recapturing missing diagnoses from the previous year, and what those financial consequences mean to the new year.

v.28 Support
Prospective and Concurrent Workflows

Health Organizations are looking for ways to grow their revenue.

Challenge

They need to identify what areas contribute the greatest financial impact.

Question

How to start executing with the quickest impact on the bottom line?

Answer

Start with value-cased care, it is proven to be the area most misunderstood and underperforming in healthcare.

Benefits of
working with us

We take a practical approach to value-based care

To be effective for Providers and CDI Departments they need a clear and transparent solution that guides them to the financial gaps without creating workflow bottlenecks.

We know what works

Because our team has experience building EHRs and Clearinghouses, our platform understands the relationship between data throughout the encounter and billing lifecycle.

We support CDI and Physician

We support many different workflow needs...whether it is pre-visit, pre-bill, or historical which include:

Prospective Reviews
Concurrent Reviews
Retrospective Reviews

And most importantly...we support Payer Contracts and manage their performance in real-time.

Finally, we are obsessed with our clients

We’ve all experienced difficulties with working with Payers, and our goal is to balance the scales in the Provider's favor while leveraging the most out of the VBC contracts.

Our platform benefits

Simplified

Make your value based care recapture activities actionable and meaningful within days versus months.

1-3 Days

By leveraging the existing claims sent to the clearinghouse, we can help you start recapturing immediately.

Benchmarking

You can easily identify interdependencies between chronic conditions and low-performing physicians, and prevent potential revenue difficulties and problems.

Execution

Close the financial gap between those interdependencies to reverse the negative leakage trends.

Understanding your ROI

Of critical importance is understanding how well your contracts are performing and how to position them in the future.

Technology

Advanced value based care software helps you complete your risk adjustment process more efficiently, improves revenue risk mitigation, and helps to position your contracts for success.

Reshape how your entire team uses data

A Successful Value Based Care Program is only as good as the data the Health Plan receives from your Billing System, so ensuring the correct diagnosis is present on the claim is critical.

Simplify your Pre-Visit analysis

Manage and analyze high-risk patients more efficiently by capturing missed HCCs and minimizing the carry-over coding Prospectively.

Empower everyone in the Mid-Cycle

Accelerate the opportunities by identifying pre-bill gaps before the claim is generated through Concurrent Workflow

Explore how to realize your recapture potential

After you initiate Prospective and Concurrent review processes, focus on disease and campaigns to increase provider education and move your calendar year recapture rate beyond 85% through Retrospective Workflow.

Govern data across your entire organization

Visualizing your organization's payment and value based care data in one place reveals opportunities and exposes trouble areas.

How does it work?

Step 1

Connect your claims to the platform

Increased case coverage
Reduced post-coding reconciliation reviews
Improved Provider response rates

Step 2

Manage and Report the progress of your Value Based Care Program

Improved financial and quality outcomes
Real-time updates identify charts with the greatest financial/quality impact opportunities and reduce your exposure to post-bill audits.

Step 3

Review your Contracts and track the performance

Select members to monitor, and identify members with a high probability of serious undocumented health conditions and missing diagnoses to improve contract performance. Truly understand the areas that need focus next.

Get connected

Maximize your investments
with simple integration tools

Many of the best EHR and RCM companies are already capable of leveraging our solutions out of the box. We connect with many other data sources to help you get more done.

Let's talk integration