Risk View™

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

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Help Improve Quality Outcomes

risk-view-drive-financial-results

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

risk-view-optimize-reimbursements

Optimize reimbursements through the most effective and efficient targets.

risk-view-increase-provider-engagement

Increase provider engagement to help achieve quality and financial goals.

risk-view-track-predict-cms-payments

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

risk-view-increase-accuracy-provider-documentation

Increase accuracy of provider documentation, coding, and billing.

risk-view-ensure-score-payment-accuracy

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

Optimize Risk Score Improvement

risk-view-strategic-planning

Strategic planning

  • 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.
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Targeted advanced analytics

  • Proprietary predictive modeling 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.
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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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