Our RiskSight Pro services leverage existing provider network(s) to promote complete and accurate documentation of the member’s health conditions in order to best close documentation and care gaps during the current date of service. Our prospective services focuses on the promotion of in-office visits with existing network providers, comprehensive in-home assessments, and a collaboration with the plan on an extensive provider education strategy.
Office Visit Coordination
For members with suspected HCCs and an established history with a provider, the PopHealthCare team connects to members to promote and facilitate an in-office visit, using a variety of communication vehicles available. Outreach tools include member mailings, IVR, email and text messaging (member opt-in required). If desired by the plan, outreach services can be supported by member and provider incentive programs. We then equip providers with analytics-driven patient information right at the point of care, enabling them to quickly record and appropriately document HCCs and close care gaps to improve quality scores
Enabled by our diagnostic model, our clinically rigorous comprehensive in-home assessment (IHA) intervention uniquely facilitates the treatment of high-risk conditions, revenue accuracy for the plans and direct closure of key quality care gaps.
Our program delivers superior results:
- Better Diagnostic Value: We find new conditions that HRA visits and chart reviews can’t. Through the physical exam, lab panels and other diagnostic evaluations, our clinically oriented interventions recapture previously documented high-risk diagnoses and confirm suspected conditions based on evidence-based guidelines. Our provider-led model fulfills CMS best practices to best optimize the new risk model.
- Better Analytical Targeting: Our sophisticated use of member and provider analytics determine each member’s projected risk score opportunity and probability of HCC capture/recapture based on member care utilization and provider documentation history. These results are calculated dynamically based on the time of year, the member’s eligibility status and the potential ROI of an in-home assessment intervention.
- Better Quality Outcomes: We fulfill care needs for up to seven Star measures and help you proactively care for members with previously unknown conditions.
Provider Education & Tools
PopHealthCare continually monitors claims and encounter data to identify targeted opportunities for education. Providers are analyzed for diagnoses gaps, documentation patterns and billing practices that lead to lost diagnoses. Targeted provider groups and providers are delivered educational materials focused on their specific opportunities for improvement. PopHealthCare empowers providers with the right tools to most efficiently and effectively capture HCC documentation and improve quality scores.
Health plan providers are given access to our Magnify platform – an interactive tool that leverages advanced analytics to present, in an easy-to-use user interface, member-specific HCC suspects and care gaps to the provider at the point of care, enabling providers to quickly record and appropriately document HCCs and close care gaps to improve quality scores.
PopHealthCare’s Magnify web-based clinical visit support tool features:
- PopHealthCare data analytics to identify previously identified and suspected conditions to the provider for quick identification of HCC diagnoses
- Care gap identification to alert providers to take action to improve care and HEDIS quality scores
- The availability of multiple formats, including web-based, electronic file formats and paper-based tools
- An auditable chart note that aligns to a clinical SOAP note format
- Provider alerts and patient history which offers a provider visibility into patient care history they may not otherwise have access to, such as ER visits and medications prescribed by another clinician
Contact us today for a free consultation and analysis of your data.