Healthcare Risk Adjustment & Quality Analytics

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Get Help with Risk Adjustment & Quality Management

Veradigm provides 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.

Our Payer Solutions 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

Payer Products

Risk Adjustment Analytics & Report: Calcul8
Quality Analytics: Qualit8
Value Based Arrangements: Evalu8
Risk Mitigation: Valid8
Provider Engagement: Collabor8
EMR Analytics & Integration: Integr8
Coding Technology: Popul8
Submissions & Reconciliation: Reconcili8

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Risk Adjustment Analytics & Reporting | Calcul8 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

Learn More About Our Risk Adjustment Analytics & Reporting Solutions

Quality Analytics | Qualit8 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

Learn More About Our Quality Analytics Solutions

Value-Based Solutions | Evalu8 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 Mitigation | Valid8 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

Learn More About Our Risk Mitigation Solutions

Provider Engagement | Collabor8 Provider engagement solution that engages healthcare providers in an efficient and respectful manner while reducing administrative burden and driving efficiencies

Leverages patent-pending 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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EMR Integration | Integr8 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

Learn More About Our EMR Integration Solutions

Coding Technology | Popul8 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

Learn More About Our Coding Technology Solutions

Submissions & Reconciliation | Reconcili8 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 Our Submissions & Reconciliation Solutions

Government Programs

Veradigm services all market 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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Risk Adjustment & Quality Management