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Enhance your prospective program with accurate condition analytics

Generate more value out of your prospective risk adjustment program by using AI to surface accurate condition recaptures & suspects and drive higher provider acceptance rates.

Care Analytics - Prospective Risk Adjustment Program Tracking

Apicare Insights: AI-powered condition suspects

Risk adjustment teams face internal financial pressure and growing regulatory pressure to move away from retrospective chart reviews for Medicare Advantage. To facilitate more accurate risk capture upstream, many organizations are implementing prospective programs that equip physician offices with information to improve condition coding, support closing care gaps, and develop a more holistic view of patient health. But developing an accurate, actionable list of diagnosis gaps and measuring performance is time-consuming and complicated. 

Apixio’s Apicare Insights solution uses high-precision AI algorithms to generate a list of suspected patient conditions that haven’t been captured on claims, powering your prospective program with reliable intelligence using existing workflows. The Apicare Insights Dashboard provides insights on program performance over time.

Supported care activities

Member prioritization using suspected & known member conditions
Member engagment & scheduling
Pre-visit chart preparation
Documentation for in-person and telehealth visits

Benefits for plans and providers

For Plans

  • Higher physician acceptance rate of diagnosis gaps
  • Reduced physician abrasion from irrelevant condition data
  • Earlier, more accurate reimbursement that reflects population risk
  • Actionable insights into your prospective program performance

For Providers

  • Reliable condition suspects to guide patient assessments and treatment
  • Improved risk capture and diagnosis gap closures during office and telehealth visits
  • Increased incentive payments from prospective risk programs
  • Fewer chart retrieval requests to support retrospective reviews
Explore how Apixio can power your prospective risk adjustment program.