Risk View™

Risk View is the risk adjustment software platform used by healthcare insurers to understand risk score trends and opportunities, help drive financial results, and optimize targets for appropriate risk-adjusted reimbursement.

Help Improve Your Risk Adjustment Outcomes

Drive financial results by understanding financial and operating goals and requirements.

Optimize reimbursements through the most effective and efficient targets.

Increase provider engagement to help achieve quality and financial goals.

Track and predict CMS payments by source data analysis and forecasting.

Increase accuracy of provider documentation, coding, and billing.

Ensure score and payment accuracy by managing the RAPS to EDS transition and compliance analytics.

Optimize Risk Score Improvement

Risk adjustment strategy tools

  • Accepted vs. actual CMS calculated scores previews payments report, giving financial insight in advance of CMS.
  • RAPS to EDS transition management planning provides insight to future risk score impact and projected payments.
  • Comprehensive end-of-year and end-of-project risk adjustment plan profile allows for informed strategic planning.

Targeted advanced risk analytics

  • Proprietary predictive risk modeling software includes risk adjustment, quality, socioeconomic, and other related data to identify member gaps and create targets.
  • Advanced models use artificial intelligence, big data, and intelligent chart selection across significantly large data assets to target most appropriate members.
  • Program flexibility identifies both retrospective and prospective intervention activities at varying cost levels to help achieve outreach objectives.

Risk adjustment activity management

  • Experienced account management team and dedicated program manager provide leadership to optimize risk adjustment activities.
  • Standardized and customized robust reports include data on risk score summaries, category distribution, member categories, and provider diagnoses to show risk score trends, population insights, and coding behavior.
  • Easy-to-use dashboard gives key metrics to support financial incentives and goals.

Providing Measurable Value

7-36x

targeting analytics ROI for Medicaid Advantage plans

1.2-4%

risk score increase for ACA plans

20+

supported insurers in covering nearly 2 million enrollees

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Additional Resources

WHITEPAPER
Risk Adjustment FAQ

Healthcare utilization varies widely among enrollees in individual markets for health insurance.

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