Health Plans and Payers

Risk Adjustment & Quality Management

Support Your Risk Adjustment & Quality Management Programs with Veradigm Payer Analytics

Veradigm Payer Analytics can provide your health plan with complete transparency into the efficacy of your Risk Adjustment, Quality Management, and Pharmacy Programs. Our solutions are geared for Health Plans and At-Risk Providers.

Veradigm’s vast array of products can address the needs of a number of functional areas, ranging from Finance, Actuary, Risk Adjustment to Quality, Network Management, and Pharmacy Program Management.

Veradigm Payer Analytics Can Help You

  • 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

  • Risk Adjustment Analytics
  • Quality Analytics
  • Veradigm Value-Based Analytics
  • Risk Mitigator
  • Veradigm Provider Engagement Solutions
  • eChart Integration and Analytics
  • Veradigm Coding Technology
  • Veradigm Comprehensive Submissions

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Risk Adjustment Analytics & Reporting Our solution that 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 as well as Value-Based Payment Models for Medicare
  • Provides the real-time visibility needed to monitor and manage risk adjustment revenue against budgeted gap closures and Key Performance Indicators (KPIs).
  • Directs intervention initiatives based on patent pending Dynamic Intervention Planning

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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, and assimilating these data in order to redirect interventions where needed most
  • Uses a robust series of analytics dashboards to help health plans deploy impactful Quality Management programs

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VERADIGM VALUE-BASED ANALYTICS Empowers payers and participating healthcare providers with analytics and insights to optimize their value-based programs

  • Produce visibility into the metrics to monitor performance of value-based contracts and arrangements
  • Assess the on-going performance of programs
  • Leverage common metrics to ensure alignment across the contracts Identify services that are being performed outside the contract

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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 RADV Audits

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VERADIGM PROVIDER ENGAGEMENT SOLUTIONS Provider engagement solution that engages healthcare providers in an efficient and respectful manner while reducing administrative burden and driving efficiencies

  • Leverages patented Dynamic Intervention Planning to identify the right intervention with the right provider at the right time
  • Provider alerts supported by Member Clinical Profiles
  • Facilitates bi-directional communication between participating healthcare providers and the gap analytic process

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E-CHART INTEGRATION AND ANALYTICS Enables the automated exchange of medical charts and facilities 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
  • Rather than sending faxes or requiring medical office staff to log into another portal, embeds analytics and alerts into the provider’s workflow
  • Enables better care coordination and faster turnaround times to improve closure rates for coding, documentation, and quality gaps

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VERADIGM CHART CODING Leverages advanced technologies to produce an accurate and efficient means for identifying, documenting, and coding members’ conditions

  • Uses Machine Learning, Natural Language Processing (NLP), and Optical Character Recognition (OCR) to identify, validate, and prepare for efficient and accurate submission
  • Optimizes coding workflows to manage both structured and unstructured data
  • Features an intuitive interface with intelligent audit capability and error-proofing

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VERADIGM COMPREHENSIVE SUBMISSIONS Scalable, flexible, integrated solution to help ensure timely, accurate, and complete EDPS/RAPS and EDGE Server Submissions

  • 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
  • Integration with our industry-leading trading platform to enable seamless EDI channel connectivity

LEARN MORE ABOUT VERADIGM COMPREHENSIVE SUBMISSIONS



Government Programs

Veradigm services all markets for risk-adjustment government programs

  • 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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