Healthcare Providers

Risk Adjustment & Quality Management

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Get Help with Risk Adjustment & Quality Management from Veradigm Payer Analytics

Veradigm Payer Analytics (formerly Pulse8), that provides complete transparency into the efficacy of your Risk Adjustment, Quality Management, and Pharmacy Programs. Payer Analytics solutions are ideal for At-Risk providers.

Veradigm Payer Analytics delivers advanced risk adjustment expertise and invaluable support to those responsible for Risk-Adjusted Revenue, Performance-based Contracting, and Quality Management.

Veradigm Payer Analytics Can Help You:

  • Succeed in risk-sharing arrangements from Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH) to CMS Star Ratings and Value-Based Payments (VBP)
  • Drive risk-adjusted revenue, outcomes-based reimbursement, and quality-driven bonuses for your practice
  • Translate analytics into action to help promote patient health outcomes

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Veradigm Payer Analytics Solutions:

  • Medical Management - Veradigm Provider Engagement Solutions + eChart Integration and Analytics
  • Quality Management – Veradigm Quality Analytics
  • Practice Management - Veradigm Provider Engagement Solutions
  • Finance & Administration – Veradigm Risk Adjustment Analytics
  • Risk Adjustment - Veradigm Risk Adjustment Analytics
  • Managed Care - Veradigm Risk Adjustment Analytics & Veradigm Provider Engagement Solutions

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MEDICAL MANAGEMENT | Veradigm Provider Engagement Solutions & eChart Integration and Analytics The user-friendly Provider Portal within Veradigm Provider Engagement Solutions and the EMR integration of our eChart Integration and Analytics technology help maximize gap closure rates while minimizing provider disruption.

  • Reduce the administrative burden of information requests by prioritizing intervention targets
  • Coordinate your efforts to close gaps in documentation, coding, and quality all at once
  • Translate analytics into meaningful action to drive positive health outcomes
  • Alerts can be delivered independently or integrated with the providers established workflows

QUALITY MANAGEMENT | Veradigm Quality Analytics NCQA certified HEDIS engine that proactively identifies trends in quality performance and can strategically prioritize quality improvement initiatives.

  • Efficiently steer your HEDIS® nurses and QI staff towards closing the most meaningful quality gaps
  • Provides the flexibility to use cardinal or ordinal measures; relative or absolute determination methods; the ACA Quality Rating System (QRS), CMS Star Ratings, or State-specific Medicaid Models
  • Advanced analytics enable QM/QI managers to only target the most fruitful intervention targets

PRACTICE MANAGEMENT | Veradigm Provider Engagement Solutions Provider engagement solution with essential dashboards and scorecards to stay on top of clinician and patient analytics

  • Evaluate your clinicians’ clinical performance, case mix, diagnostic capture rates, and coding efficacy to identify those who might benefit from ongoing education and/or additional support staff.
  • Stay on top of your patient panel
  • Maintain your own patient profiles and analytics framework so that you can understand the risk-related data of your practice

RISK ADJUSTMENT ANALYTICS & FINANCIAL REPORTING | Quality Analytics Risk adjustment, pharmacy analytics and financial reporting solution to help you maintain a watchful eye on your practice’s risk-based contracts

  • Enables the ability to monitor how well your practice is performing on your risk-based contracts when compared to expectations.
  • Accurately helps your practice predict Medicare Advantage final year and/or mid-year risk adjustment results and ACA Commercial Transfer Payment Revenue
  • ACA Commercial Modeler can calculate the RAF Points your practice needs to reach budget and the optimal intervention level, timing, and type with which to get there.

RISK ADJUSTMENT | Veradigm Risk Adjustment Analytics Risk adjustment analytics and reporting solution to improve your confidence levels and predictive capabilities regarding individual patient risk factors

  • Combines advanced risk adjustment analytics with Big Data mining to produce precise and actionable risk adjustment algorithms in Managed Medicaid, ACA Commercial, and Medicare Advantage markets.
  • Patent pending Dynamic Intervention Planning helps target gap closure strategies to the right patient at the right time
  • Helps avoid pursuing low-yield interventions that may have little to no impact on risk scores

MANAGED CARE | Veradigm Risk Adjustment Analytics & Veradigm Provider Engagement Solutions Solutions for managed care contracting teams to reduce administrative burden and drive practice efficiencies

  • Leverage Veradigm Risk Adjustment Analytics (formerly Calcul8) to project the impact of the revenue and risk scores for each contract
  • Veradigm Provider Engagement Solutions (formerly Collabor8) dashboards can help uncover details about high-cost patients who may disproportionately affect your practice’s risk profile
  • Translate analytics into meaningful action to drive positive health outcomes

Learn more about Risk Adjustment & Quality Management solutions for your practice

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