Software

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.

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Help ImproveYour Risk Adjustment Outcomes

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

  • Increase provider engagement to help achieve quality and financial goals.

  • Increase accuracy of provider documentation, coding, and billing.
  • Optimize reimbursements through the most effective and efficient targets.

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

  • 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

36x

targeting analytics ROI for Medicaid Advantage plans (maximum result)

4 %

risk score increase for ACA plans (maximum result)

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20 +

supported insurers in covering nearly 2 million enrollees

Our outcomes

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Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Case Study

Chart Recoding and Reprocessing Yields Substantial Gain

Learn how an AI-driven review of a health plan’s Medicare Advantage claims produced an annualized gain of $357,000

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Video

Optimizing Risk Analytics with a Data Integration Cloud

Video

Optimizing Risk Analytics with a Data Integration Cloud

Learn how our Integrated Delivery Platform aggregates data from disparate systems to: Optimize risk analytics, Ease compliance with CMS mandates, and more.

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On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

On-demand Webinar

Convergence of Risk, Quality & VBC: A Focus on Medicaid

Watch this AHIP webinar to discover best practices for integrating risk, quality, and value-based care to improve outcomes and manage costs for Medicaid enrollees.

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Resources and brochures

Whitepaper

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

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