Full-spectrum integrated risk adjustment solutions

RiskSight®

RiskSight provides PopHealthCare clients with valuable visibility into the future. This unique risk-adjustment and revenue-management solution features analytic and forecasting services and tools and prospective and retrospective risk adjustment interventions that close Hierarchical Condition Categories (HCC) and quality gaps.  

RiskSight Services

 

PopHealthCare designed RiskSight to optimize our clients’ program investments. RiskSight analytic and forecasting services offer revenue and ROI visibility through the monitoring of a health plan’s risk adjustment management initiatives. These services provide actuarial support for bid analysis and financial forecasting. RiskSight Retro combines our chart-targeting analytics and prioritization and focuses on maintaining a greater ROI for our clients by maximizing successful chart retrieval and by uncovering new and incremental Hierarchical Condition Categories (HCCs). RiskSight Pro features office visit coordination and our clinically rigorous comprehensive in-home assessment (IHA) intervention, both of which facilitate the treatment of high-risk conditions, revenue accuracy, and direct closure of key quality care gaps.

Determining the Right Intervention

At PopHealthCare, our goal is to help high-risk patients get the care they need – when and where they need it most. To achieve this goal, our proprietary algorithms use all available data sources to identify suspected HCC conditions and to evaluate member and provider patterns to determine where provider office visits are not occurring or are not a reliable source of comprehensive diagnostic information and where high-risk members would benefit from an in-home assessment. These analytics ensure that members are then prioritized and assigned to the most appropriate intervention.

 

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Ongoing Claim Review

Monitoring claims and encounter data for an expected visit, based on historical care and provider documentation patterns.

 

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Retrospective Chart Review

An existing claim exhibits high likelihood that documentation of HCC is present in the medical record, targeting for review.

 

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In-Office Visit Facilitation

Historical care patterns show that a provider relationship is present, but there is a need to promote a visit to occur in the calendar year.

 

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In-Home Assessment 

If no provider relationship is present and there is a high cost-benefit opportunity, the member is targeted for an in-home visit.

 

 

Getting Started

Contact us today for a free consultation and analysis of your data.