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Quality Management

Healthcare Risk Adjustment and Quality Management

Clearinghouse + EDI


Offering a unified solution through one vendor, Veradigm Payer Analytics provides a bidirectional connection that helps ensure end-to-end efficiency. Our approach to risk management optimizes your financial performance while enhancing risk and quality scores, all through one cohesive, easy-to-navigate path.

Veradigm Payer Analytics

Support Your Risk Adjustment & Quality Management Programs

Veradigm Payer Analytics offers a comprehensive suite of solutions that can provide your health plan with complete transparency into the efficacy of your Risk Adjustment, Quality Management, and Pharmacy Programs. These quality and risk adjustment tools are essential for Health Plans and At-Risk Providers as they navigate the complexities of healthcare.

Effective risk adjustment in healthcare is crucial for accurate funding and patient care optimization. Veradigm addresses the needs across various functional areas such as Finance, Actuary, and Pharmacy Program Management, ensuring that every dimension of your healthcare strategy is covered.

Our sophisticated solutions support improved outcomes to the benefit of everyone involved in the cycle of care.

Veradigm Payer Analytics Can Help You

Payer Analytics from Veradigm utilizes cutting-edge risk adjustment software that aligns the right providers at crucial moments.

  • Close gaps and enhance financial performance
  • Improve risk and quality scores
  • Deploy the right intervention, with the right provider, at the right time

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Veradigm Payer Analytics Solutions

Veradigm Payer Analytics is a comprehensive suite of solutions designed to optimize healthcare management and delivery. Each component is tailored to enhance the operational and clinical outcomes for health plans and at-risk providers, helping to ensure a holistic approach to healthcare management.

  • Risk Adjustment Analytics: Enhance accuracy in patient risk profiling.
  • Quality Analytics: Improve healthcare outcomes and quality scores.
  • Risk Mitigator: Support effective risk mitigation in healthcare for RADV audits.
  • Veradigm Provider Engagement Solutions: Enhance collaboration and efficiency among providers.
  • eChart Integration and Analytics: Streamline data integration and analysis from EHRs.
  • Veradigm Coding Technology: Advanced solutions for medical coding accuracy.
  • Veradigm Comprehensive Submissions: Facilitate efficient data submissions for compliance and reporting.

Explore our suite of healthcare risk management software in more detail to find the best solution for your needs.

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Risk Adjustment Analytics & Reporting Our solution helps plans avoid administrative waste, optimize risk-adjusted revenue, and dynamically deploy intervention initiatives.

  • Delivers advanced risk adjustment analytics to the ACA Commercial, Medicare Advantage, and Managed Medicaid Markets
  • Delivers real-time gap closure rates, risk factor, and risk revenue projections
  • Directs intervention initiatives based on patented Dynamic Intervention Planning

LEARN MORE ABOUT RISK ADJUSTMENT ANALYTICS


Quality Analytics Uses predictive analytics and Dynamic Intervention Planning to prioritize gap closure efforts for Quality Rating Systems, Star Ratings, and Medicaid.

  • An NCQA Certified HEDIS engine to help close quality gaps and improve quality scores
  • Advanced analytics for monitoring, measuring, and reporting on each quality metric — assimilating the data to redirect interventions where needed most
  • Uses a robust series of analytics dashboards to help health plans deploy impactful Quality Management programs

LEARN MORE ABOUT QUALITY ANALYTICS


Risk Mitigator Assists health plans guard against the financial consequences of a RADV Audit.

  • Quantifies and identifies the healthcare providers and conditions that are putting the plan at risk of an audit
  • Deep analytics uncover actionable tactics that can be deployed for research, correction, and provider education
  • Enabled for both HHS RADV and Medicare OIG/RADV Audits

LEARN MORE ABOUT RISK MITIGATOR


VERADIGM PROVIDER ENGAGEMENT SOLUTIONS Provider engagement solution that effortlessly engages healthcare providers, minimizes administrative burden, and boosts overall efficiency.

  • Provider alerts are supported by our risk and quality analytics solutions
  • Facilitates bi-directional communication between participating healthcare providers and the gap analytic process
  • Offers customer configuration for Payers to target the alerts they want to close
  • Provides access to an educational resource library for a deeper understanding of documenting care management within Risk Adjustment and Quality programs

LEARN MORE ABOUT VERADIGM PROVIDER ENGAGEMENT SOLUTIONS


E-CHART INTEGRATION AND ANALYTICS Enables the automated exchange of medical charts for payer/provider collaboration.

  • Eliminates the need for more costly and labor-intensive means of data collection by automating the extraction of CCDA/medical record information
  • Enables faster turnaround times to improve gap closure rates — coding and documentation
  • Immediate connectivity to over 400,000+ providers in the Veradigm Network with multiple types of EHRs for chart retrieval services

LEARN MORE ABOUT E-CHART INTEGRATION AND ANALYTICS


VERADIGM ECHART CODER Leverages advanced technologies to produce an accurate and efficient means for identifying and coding members’ conditions.

  • Computer-assisted Coding (CAC) utilizing Natural Language Processing (NLP) and Optical Character Recognition (OCR) to identify, validate, and prepare for efficient and accurate submission
  • Optimizes coding workflows to utilize big data and advanced search algorithms on structured and unstructured data
  • Features an intuitive interface with error-proofing and intelligent audit capability

LEARN MORE ABOUT VERADIGM ECHART CODER


VERADIGM COMPREHENSIVE SUBMISSIONS Scalable, flexible, integrated solution to help ensure timely, accurate, complete, and compliant encounters for all government-sponsored programs.

  • Complete and accurate tracking and status-monitoring of all encounters with end-to-end visibility into member claims data
  • Workflows configurable for batch corrections, reviews and approvals, and re-submissions to enhance workforce efficiency
  • Validates 100% of claims data to enable 98%+ acceptance rate
  • Integration with our industry-leading trading platform to enable seamless EDI channel connectivity

LEARN MORE ABOUT VERADIGM COMPREHENSIVE SUBMISSIONS



Government Programs

Veradigm healthcare risk management software caters to various markets for risk-adjustment government programs, including those managing Medicare risk adjustment. Learn more about the government programs Veradigm services.

  • ACA: ACA Commercial / Qualified Health Plans (QHPs)
  • MA: Medicare Advantage
  • MEDICAID: Managed Medicaid
  • DUALS: Dual Eligible
  • SNP: Medicare Special Needs Plans (SNP)
  • PCMH: Patient-Centered Medical Homes (PCMH)
  • ACO: Accountable Care Organizations (ACO)
  • MACRA: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

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