Solutions for At-Risk Providers

Providers, large and small, are entering more and more risk-sharing arrangements.  From Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH) to CMS Star Ratings and Value-Based Payments (VBP), a convergence is occurring among risk-adjusted revenue, outcomes-based reimbursement, and quality-driven bonuses.  Nothing epitomizes this convergence better than the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), both of whose payment tracks marry quality reporting, value-based reimbursement, meaningful use, and risk adjustment all together.  The resulting complexity demands the coordinated involvement of many departments within today’s medical group – not just Finance, but Medical Management, Managed Care, Quality, and Case Management.

Pulse8 has advanced analytic solutions to help all of these teams succeed.  We also have the wealth of applied, practical experience at risk adjustment, quality management, and provider engagement needed to translate analytics into action.

Here are the most frequent uses of our products within the medical group community:

Medical Management:

Maximize gap closure rates while minimizing provider disruption by leveraging the user-friendly Provider Portal within Collabor8 and the EMR integration of our Integr8 technology. Pulse8’s products spare your providers and their staff the annoyance and productivity drain of repetitious and sometimes unnecessary information requests by prioritizing your targets and coordinating your efforts to close gaps in documentation, coding, and quality all at once. Pulse8 can help you “stay skinny” by focusing on just the ideal interventions,

Quality Management:

Proactively identify trends in quality measure performance and strategically prioritize quality improvement initiatives using Qualit8 in order to optimally deploy your HEDIS® nurses and QI staff towards closing the quality gaps that will produce the greatest economic value. Whether working with cardinal or ordinal measures; relative or absolute determination methods; the ACA Quality Rating System (QRS), CMS Star Ratings, or State-specific Medicaid Models, Pulse8’s advanced analytics can steer QM/QI managers down the most fruitful paths.

Practice Management:

Use the provider scorecard and dashboards within Collabor8 to evaluate your clinicians – from case mix and clinical performance to coding efficacy and diagnostic capture rates – in order to identify those in need of ongoing education and/or additional support staff. Leverage Collabor8 to also stay on top of your patient panel. Patients switch health plans all the time: Don’t rely on their health plan “du jour” to supply you with the essential risk-related data; maintain your own analytic framework and patient profile.

Finance and Administration:

Use our Calcul8 Financial Reporting Suite to monitor how well you are performing on your risk-based contracts versus expectations. Calcul8 helps you maintain a watchful eye over your risk adjustment programs and our dashboards lend a pre-emptive hand when maneuvers need to be made. No vendor can more accurately predict Medicare Advantage mid-year or final year risk adjustment impact and ACA Commercial Transfer Payment Revenue, and our ACA Commercial Modeler is the ultimate tool for calculating the RAF Points needed to achieve budget and the optimal intervention type, level, and timing with which to get there.

Risk Adjustment:

Improve your predictive capabilities and confidence levels regarding individual member risk factors with our flagship Calcul8 product, which combines the most advanced risk adjustment analytics with Big Data mining and multiple predictive models to produce the most precise risk adjustment algorithms in the ACA Commercial, Medicare Advantage, and Managed Medicaid markets. Risk Adjustment staff rely on Reveal8 to differentiate gap closure strategies depending on whether conditions are “persisting” or “suspecting” and to avoid pursuing low-yield interventions that will produce little to no impact on risk scores.

Managed Care:

Your managed care contracting department will rely on Calcul8 to project the impact of the risk score and revenue for each contract. Granular details about the high-cost patients who disproportionately affect your risk profile can be gleaned through Collabor8 dashboards, such as Member Clinical Profile.

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Solutions for Health Plans

Pulse8’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.

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