Today’s U.S. healthcare system is incredibly complex. The pressures of healthcare funding require constant attention to — and revenue accuracy for — payors and health plans. This is where the analytics-based innovations of PopHealthCare can make a difference, by helping high-risk patients get the care they need – when and where they need it most.

Why We're Different

At PopHealthCare, our mission is to bring leading-edge health care solutions to the people who need it most. That’s why we’re dedicated to helping higher risk individuals live healthier lives.

To accomplish our goals, we’ve reimagined and reengineered the health care system in a way that enables our clients to improve patient care and better manage costs.

 

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We’ve successfully proven that sophisticated analytics can be a real catalyst in the development of compassionate, properly funded clinical care. We believe that by creating a harmony between cost savings and patient care, we can improve the health of high-risk populations, one person at a time.

What We Do

At PopHealthCare, we take a three-step approach to delivering compassionate care to high-risk populations.

We call this our “Three F’s”: Find, Fund, and Fulfill.

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We’ve been refining and perfecting this approach for over a decade, building a comprehensive approach that enables us to bring the best possible care to those who need it most.

WE FIND opportunities through the use of sophisticated analytics:

  • We seek out high-risk/high-cost individuals in need of high intensity care.
  • We pursue care opportunities to improve treatment and meet quality standards.
  • We identify suspected diagnoses predictive of health risks and in need of confirmation and capture, in order to both improve patient care and enact accurate premium risk adjustments to fund that care.

WE FUND programs through improved cost management that delivers both near-term and long-term ROI:

  • We consistently deliver high ROIs for our clients as they serve some of the most expensive and vulnerable populations in the country.
  • We drive rapid, substantial, and measurable revenue improvement through risk-adjustment mechanisms to fund quality investments.
  • We inform and empower quality investments that quickly result in additional positive ROI from fewer unnecessary inpatient events and more quality bonuses earned.

WE FULFILL patients’ needs through improved, compassionate care:

  • We engage providers with actionable information and easy-to-use technology tools to improve in-office care and documentation.
  • We deliver care and support to individuals with the highest needs, using PopHealthCare in-home care providers and field staff.
  • We close gaps in Quality, Care, and Diagnoses, as well as Risk Documentation and Submission.

 

Who We Serve

  • Medicare Advantage
  • Managed Medicaid
  • Health Insurance Exchanges/Marketplace
  • Small Group and Individual Health Plans
  • Accountable Care Organizations & Providers
  • Dual Eligible & Dual Integrated

 

Our Leadership

Over the past decade, PopHealthCare has analyzed data for millions of members, reviewed tens of millions of medical records, and consistently delivered high ROIs to our loyal clients who serve some of the most expensive and vulnerable populations within the U.S. healthcare system. Many of our senior leadership and analytics team members have been involved in the development and administration of Medicare HCC optimization initiatives since 1999.

Today, our executive leadership and management teams strive to develop and deploy groundbreaking programs in high-risk population care to redefine the care delivery model.

Get Started

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