HCC Optimizer Streamlines Risk Adjustment

Industry Challenge: The HCC Coding Problem

Risk adjustment is the process of determining a patient's health status to predict cost of care during a specific time period. The Medicare Advantage (MA) program uses risk adjustment methodology to set annual capitated payment rates to contracted health plans based on a Hierarchical Condition Category (HCC) model called CMS-HCC. Payment from the Medicare Advantage program to Health Plans increases...

Big Data Reveals Crucial Hidden Information in Healthcare Systems

Health Technology Use Case

Technology leaders in healthcare know that managing risk for a population requires a highly informed, data-driven approach to tracking the care of patients. The challenge is that coded data from administrative sources falls far short of faithfully representing the clinical history of a patient. Studies show that more than...