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Increase your risk capture with prospective intelligence

With CMS pressure to move away from retrospective risk adjustment activities, many health plans are adopting prospective programs to improve physician documentation and coding and remove the need for costly and burdensome chart pulls and reviews. Artificial intelligence is critical to identifying and targeting members with likely HCCs.

Prospective Insights - Prospective Risk Adjustment Suspecting

Prospective Insights: The proactive risk adjustment solution

Apixio’s Prospective Insights solution uses proprietary AI algorithms to generate suspected conditions from analysis of medical charts and claims data. These suspects are then prioritized and routed to industry-leading clinical documentation improvement solutions for physician action. AI can best identify individuals with suspect conditions for physicians to address, document, and code at the point of care.

Benefits of Prospective Risk Adjustment

Benefits of prospective risk adjustment

Retrospective risk adjustment requires significant time and resources from healthcare organizations. Health plans must retrieve charts from offices and hospitals, code patient charts, and submit new codes to CMS. This process places a significant burden on physicians, hospitals, and payers, costs billions of dollars, and faces increasing regulatory pressure each year. Prospective risk adjustment reduces the operational lift required from both plans and providers. By moving risk assessment into a clinical setting, plans reduce chart pulls and provider abrasion, and obtain more timely information about clinical care.

Ready to take on prospective risk adjustment?