Calcul8

Risk Adjustment Analytics & Reporting

Accurately measuring your Risk Adjustment opportunity and dynamically deploying your intervention initiatives in order to optimize risk-adjusted revenue, avoid waste, and minimize provider abrasion

Pulse8's flagship product, Calcul8, delivers the most advanced risk adjustment analytics to the ACA Commercial, Medicare Advantage, and Managed Medicaid Markets as well as Value-Based Payment Models for Medicare. Using Big Data mining, clinical inferencing, and multiple predictive models, we deliver the most precise, confidence-adjusted risk adjustment algorithms to ensure that our clients outperform their competitors. Calcul8 delivers the real-time visibility needed to monitor and manage risk adjustment revenue against budgeted gap closures and Key Performance Indicators (KPIs).

Key features of the analytic engine that delivers the greatest risk-adjusted returns:

  • Directs intervention initiatives based on our patent-pending Dynamic Intervention Planning
  • Projects MYRA and FYRA results by Contract and PBP
  • Monetizes Gap Closures as contribution to year-end ACA risk transfer payment
  • Performs Annual True-Up on Retrospective Rate Adjustments by state for each Medicaid population (TANF, SSI, ABD, and Duals)
  • Projects the likelihood of achieving the Shared Savings Cap in the NextGen ACO Program and the number of closed gaps needed to hit the cap
  • Delivers real-time Gap Closure Rates, ROI, and Risk Factor Projections

Pulse8's Illumin8 Active Intelligence platform leaves no stone unturned by leveraging a vast array of information, including medical and pharmacy claims, lab results, care management data, health risk assessments, medical records, and "off the data grid," non-traditional information. Calcul8 then scores each opportunity and calibrates the confidence level by reviewing member and provider behavior patterns, along with the frequency, potency, and reliability of each data source.

After calculating "confidence-adjusted" risk scores, Calcul8 prioritizes all possible opportunities and recommends the optimum intervention strategy through our Dynamic Intervention Planning for efficiently closing each documentation, coding, and quality gap deemed worthy of pursuit.

Whether running an ACA Commercial, Medicare Advantage, Medicaid, or Value-Based Payment model for Medicare, Calcul8 is the ultimate tool for enabling you to accurately project the RAF points, HCCs, or Condition Types needed to achieve budget - and the intervention type, level, and timing with which to get there.

In summary, Calcul8 delivers the most accurate financial projections and the most efficient intervention roadmap. Calcul8 provides the most precise Transfer Payment Revenue Projections (TPRP) within the ACA Commercial market, Mid-Year and Financial Year Risk Adjustment impact analyses (MYRA and FYRA) within Medicare Advantage, Annual True-Ups on Retroactive Rate Adjustments in Medicaid, and Shared Savings Payments in NGACO, MSSP, and other VBP programs.

Calcul8 couples the most effective Gap Identification methodology with the most efficient Gap Closure strategy to ensure that our clients pursue the right member and provider with the right intervention at the right time. We "tailor our touches" to optimize your gap closure rates and risk adjustment ROI.

Calcul8 is the financial instrument that helps risk-bearing entities to navigate the complexity of financial reporting, while avoiding the pursuit of unnecessary and wasteful gap closure activities.

Stop wasting money, increase your financial reimbursement.
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For all general and sales inquiries, please contact us at 410.928.4218 or email us at info@pulse8.com
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