Risk Adjustment

Veradigm Health Equity Analytics

Clearinghouse + EDI

Going beyond Social Determinants of Health (SDoH) to include demographic and socioeconomic data to identify at risk members.

Using Analytics to Advance Health Equity

The healthcare industry is moving towards a more data-driven approach to improve member outcomes, reduce costs, and promote equity. Veradigm Health Equity Analytics, an add-on to Veradigm® Risk Adjustment Analytics, advances the insights of Risk Adjustment Analytics by incorporating Social Determinates of Health (SDOH) to identify at risk members. This solution identifies members who are at higher risk of adverse health events and supports the development of supportive care plans. Traditional risk adjustment methods often fail to capture the SDOH that contributes to health inequities. As a result, there is a need to include health equity analytics to risk adjustment analytics to improve health outcomes, reduce costs, and promote health equity.

By understanding a person’s social determinants, health plans can leverage targeted workflows to complete gap closures and address the whole-person care needs. Health Plans may also use population data to determine what benefits to include in their Medicare Advantage Bid.

Veradigm Health Equity Analytics may have a significant impact on Analytics and Reporting solutions by incorporating member and community information for a holistic view, with a goal of improving health outcomes for diverse populations.

By providing a comprehensive understanding of health disparities and inequities, Health Equity Analytics can inform the development of targeted interventions and programs that promote equitable access to healthcare services and address the root causes of member behavior. Current domains include housing, transportation, food, education, employment, and economic status.

Learn More About Veradigm Health Equity Analytics

Solution can help you:

  1. Cost savings: By addressing health inequities, payers can prevent costly complications, hospitalizations, and emergency room visits that arise from untreated or poorly managed conditions. Providing timely and effective care, at the member’s point of care, can lead to better health outcomes and reduced long-term healthcare costs.
  2. Population management: Payers need line of sight into their membership to attract and retain members. By understanding health inequities and being able to offer supplemental benefits related to supporting those in need, health plans can better understand and manage their population.
  3. Enhanced member satisfaction and retention: When payers proactively support holistic care and closing gaps, it demonstrates a commitment to their members' health and well-being. By providing comprehensive and coordinated care, payers can improve member satisfaction, leading to higher retention rates and increased loyalty to their programs.
  4. Risk mitigation: Addressing SDOH gaps helps payers mitigate risk by identifying and managing health issues before they become more severe or costly to treat. By implementing proactive interventions and preventive strategies, payers can reduce the financial risk associated with high-cost, complex medical conditions.
  5. Competitive advantage: Payers that excel in identifying and supporting benefits in SDOH care differentiate themselves in the market. Offering transportation credits, food boxes, and personalized health management can attract new members, employers, and contracts. It positions payers as leaders in delivering high-quality, value-based care, and strengthens their market position.
  6. Regulatory compliance: Payers are often subject to regulatory requirements and quality standards. There are increased regulations proposed on how to standardize SDOH data and health plan requirements. It reduces the risk of penalties or legal issues related to non-compliance.

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