Medvensys Risk360™ allows payers and risk-bearing providers to identify suspect conditions that are under-documented and that have gone undocumented. In addition, the platform assigns the right interventions for each HCC/RAF gap to address gaps considering their propensity of closure during the required coverage periods.
Analyze all available administrative and clinical datasets to assess the clinical profile of every member along with diagnosis and documentation gaps.
From under-coded to un-coded to un-assessed, identify all diagnosis (or HCC) gaps along with their payment improvement potential for all populations.
Provide the right care to all members along while improving risk-adjusted reimbursement by integrating care/quality programs with Risk Adjustment.
Continuously measure provider performance (as against the metrics and targets) during the benefit-years to offer proactive support
Generate sustainable clinical and financial improvements by engaging providers with the right programs (education, gap-closure etc.) at the point-of-care.
Ensured high predictive accuracy by deploying hundreds of clinical algorithms which are converted into analytics by applying various advanced statistical methods.
Integrate quality/care gaps and potential adverse events (ER utilization, readmissions, preference sensitive treatments etc.) with RAF/HCC gaps and drive provider engagement to improve plan-level clinical and financial performance.
Significantly improve network efficiencies by leveraging top performers and supporting low-performing providers through varied provider collaboration strategies.
Proprietary analytical models enable decision makers to identify suitable value-based reimbursement strategies that improve risk-adjusted revenues.
Enhance provider performance by providing targeted recommendations via performance reports to drive continuous clinical and financial improvements.