Over 250 organizations have sponsored RISE and the RISE Institute over the past three years. If you aren't on this list you are missing out!
Health Fidelity’s risk adjustment solution is the most comprehensive, scalable solution in the market for perfecting the risk adjustment cycle. Our cutting-edge technology combines big data analytics and natural language processing (NLP) to automatically extract valuable insights from medical charts to enhance prospective and retrospective RAF processes. Equipped with this proprietary technology and a team of industry experts, Health Fidelity can help organizations optimize their coding operations to increase efficiency, achieve better compliance, and maximize value through improved identification of HCCs.
Inovalon is a leading technology company providing cloud-based platforms empowering a data-driven transformation from volume-based to value-based models throughout the healthcare industry. Leveraging large-scale data interconnectivity capabilities, unparalleled proprietary data sets, advanced analytics, data-driven intervention systems, and industry-leading subject matter expertise, Inovalon enables the assessment and improvement of clinical and quality outcomes and financial performance across the healthcare ecosystem. From health plans and provider organizations, to pharmaceutical, medical device, and diagnostics companies, Inovalon's unique achievement of value is delivered through the effective progression of “Turning Data into Insight, and Insight into Action®.” Providing technology that supports nearly 500 healthcare organizations, Inovalon's platforms are informed by data pertaining to more than 858,000 physicians, 377,000 clinical facilities, and 230 million Americans, and nearly 30 billion medical events.
Integra ServiceConnect engages members through deeply personalized face-to-face interaction, driving increased participation in risk adjustment, case management, and other clinical and quality outcome initiatives. Our team of highly-trained outreach specialists are consistently successful in reaching up to 50% of members that cannot or have not been engaged through standard outreach campaigns.
Integra’s services can be used for short-term, targeted initiatives or high-touch, long-term programs, and can be customized to meet a plan’s specific needs for members in any market and line of business. We seamlessly integrate into the programs and vendor relationships that are already in place, and can be running within 90 days. Our services have been used to engage members for in-home assessments and health risk assessments, connect members to case management, close members’ care gaps, and coordinate better care for members by addressing the social determinants of health.
In-person engagement of high-risk, high-need members delivers superior results. Developed over time, Integra’s disciplined approach includes hiring the right staff and equipping them with the training and tools necessary to achieve high levels of member engagement and satisfaction. Our confidence in our unique people-finding methodology is high, so we are success-fee only.
In the field, Integra acts as an ambassador, demonstrating the plan’s commitment to educating and connecting members with appropriate services. Moving beyond call center campaigns, our solutions ensure appropriate risk adjustment revenue while improving medical management and quality measures for the plan.
Matrix Medical Network is the leader in supporting care in the home through our national network of Nurse Practitioners. From in home assessments to chronic care support, Matrix helps health plans engage members and their physicians to ensure members receive needed care, improving their health and overall outcomes.
Optum is a health services company with more than 35,000 people dedicated to making the health system work better for everyone. Our solutions and services are used at every point in the health system, from provider selection to diagnosis and treatment, and from network management, administration and payments to the innovation of better medications, therapies and procedures.
Optum helps solve the fundamental challenges facing the health system with unmatched depth and breadth of capabilities, a diverse portfolio of innovative health services and technologies and the exceptional expertise of our people. Our solutions and capabilities:
Provide physical and mental health information and services to more than 60 million Americans – helping them and other health organizations navigate the system, finance their health care needs and attain their goals.
Improve the performance of the health system with analytics, technology and services that enable better decisions and results.
Assist with clinical management and delivery of prescription medications and consumer health products.
Every day, we shape how health care is managed, and how information and technology drives improvements in the system. Optum works with our clients and partners to improve the delivery, quality and cost effectiveness of health care in ways that support and empower more patient-centered, value-driven care.
Prognos is a healthcare AI company focused on eradicating disease by driving decisions earlier in healthcare in collaboration with payers, Life Sciences and diagnostics companies. The Prognos Registry is the largest source of clinical diagnostics information in over 30 disease areas, with over 5B medical records for 100M patients. Prognos has 500 extensive proprietary and learning clinical algorithms to enable earlier patient identification for enhanced treatment decision-making, risk management and quality improvement. The company is supported by a $23M investment from Safeguard Scientifics, Inc. (NYSE:SFE) and Merck Global Health Innovation Fund (GHIF). For more information, visit www.prognos.ai.
Pulse8 is a cutting-edge healthcare technology and analytics provider that delivers an unprecedented view into risk adjustment so health plans can achieve the highest financial impact in the Commercial Health Exchanges and Medicare Advantage markets. Its proprietary algorithms move beyond traditional methods and data sources to make predictions about what individual members require next, ultimately closing gaps in care and increasing precision with risk adjustment initiatives. Pulse8 offers innovative and unique methodologies in its Health Exchange Suite™ to ensure its clients outperform the marketplace. Its transparent and flexible business intelligence tools give real-time visibility into member and provider behaviors allowing clients to apply the most cost-effective and appropriate interventions. For more company information, please contact Pulse8 at (410) 928.4218 or visit http://www.Pulse8.com and follow Pulse8 on Twitter at https://twitter.com/Pulse8News
Talix provides patient risk management solutions to help healthcare organizations address the challenges of value-based healthcare and risk-based contracts. Its SaaS applications leverage patient data analytics to turn structured and unstructured health data into actionable insights that drive improved risk adjustment, better patient outcomes and reduced costs.
Ciox Health facilitates and manages the movement of health information with the industry’s broadest provider network. Through our expertise in release of information, record retrieval, and HIM, we improve the management and exchange of health information by modernizing workflows, facilitating access to clinical data, and improving the accuracy and flow of health information.
Episource provides a complete and integrated set of services and products to simplify the way Medicare, Commercial and Medicaid health plans manage their Risk Adjustment and Quality programs. We work with health plans and healthcare organizations to absorb the most challenging aspects of program implementation, operations, and management. We simplify by modernizing workflows to better assess the full cycle of Risk Adjustment and Quality programs to improve clinical outcomes and financial performance.
Our services include: Retrospective Chart Reviews, HCC Gaps and RAF Campaign Workflow (epiAnalyst), Encounter Data Error Resolution and Financial Analytics (epiEncounter), HEDIS & STARS Analytics & Reporting, Gaps in Care Reporting, and HEDIS Retrieval & Abstraction. We also offer clinical services such as HRAs (Health Risk Assessments) and NP programs.
For more company information, please contact Claudia Gallardo at (424) 295-0491, visit us at www.Episource.com, or follow us on Twitter @EpisourceLLC
DST Health Solutions, LLC delivers contemporary healthcare technology and service solutions that enable its clients to thrive in a complex, rapidly evolving healthcare market. Supporting commercial, individual, and government-sponsored health plans, health insurance marketplaces, and healthcare providers, DST Health Solutions’ services include enterprise payer platforms, population health management analytics, care management, and business process outsourcing solutions, each designed to assist a company manage the processes, information, and products that directly impact quality outcomes. DST Health Solutions is a wholly-owned subsidiary of DST Systems, Inc. For more information visit www.dsthealthsolutions.com.
Tessellate helps clients exceed their goals with provider-centric, low-abrasion solutions that can be implemented quickly and deliver value. Our risk adjustment, quality and provider engagement programs for health plans and provider organizations are designed to improve revenue integrity and quality of care, while lowering administrative costs. For more information, please contact Will Stabler at 804.310.9908 or firstname.lastname@example.org. You can also visit us at www.tessellate.com. For exciting updates and information, also check us out on our Facebook, LinkedIn, and Twitter page.
As healthcare adapts to an aging demographic, new payment models, and the rising cost of care, our clients face increasingly complex clinical and financial risk. Verscend Technologies (formerly Verisk Health) drives better healthcare outcomes through data analytics. Our solutions help organizations organize and optimize their data so they can efficiently and cost-effectively succeed in the new era of healthcare.
We offer an array of solutions that create value across four major functional areas:
Payment Accuracy: fraud, waste, and abuse solutions that ensure accurate payment and cost containment
Revenue Integrity: solutions that simplify commercial, Medicare, and Medicaid risk adjustment initiatives and ensure appropriate funding for members and their conditions
Quality Improvement: end-to-end support for unified quality measurement, reporting, and improvement
Population Risk Assessment and Stratification: decision analytics, including DxCG risk adjustment models and reporting solutions
Verscend has extensive experience helping healthcare payer organizations use their data in meaningful ways. We currently serve than 200 health plans, including regional and national plans with commercial, Medicare, Medicare Advantage, and Medicaid lives. Over more than two decades, we have built a reputation for the knowledge and integrity our team, our ability to organize data for smarter solutions, and our history of delivering quantifiable results.
For more information, please visit www.verscend.com.
Change Healthcare is inspiring a better healthcare system. Change Healthcare is a key catalyst of a value-based healthcare system – working alongside our customers and partners to accelerate the journey toward improved lives and healthier communities. While the point of care delivery is the most visible measure of quality and value, we are a healthcare technology solutions company that uniquely champions the improvement of all the points before, after, and in-between care episodes. With our customers and partners, we are creating a stronger, better coordinated, increasingly collaborative, and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.
Apixio is the leading provider of Big Data analytic solutions for risk-bearing healthcare organizations seeking to optimize costs and outcomes. Apixio transforms coded, textual and scanned data into real-time insights that enhance risk assessment, population management and reimbursement. Apixio’s solutions seamlessly integrate into clinical and administrative workflows, allowing clients to reap immediate benefits and achieve continued success in a rapidly changing healthcare environment.
Discovery Health Partners offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience. We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results.
About Signify Health
Signify Health partners with leading health plans, healthcare providers, and technology companies to improve quality of life by providing comprehensive care where and when it's needed most. With an innovative logistics and clinical workflow technology platform, exhaustive data set, and an unparalleled national clinical network, the company provides tech-enabled care services to vulnerable populations within the routine of their daily lives to improve health and quality of life. Signify Health serves well over one million health plan members each year, providing health risk evaluations, complex care management, and specialized medical services in the home and other convenient locations.
Headquartered in Ann Arbor, Michigan, ATTAC Consulting Group (ACG) specializes in compliance solutions, auditing, business operations and process controls, for insurers and healthcare organizations. ACG focuses on the space between what’s supposed to happen on paper and what’s actually happening on the ground. Our firm assists our clients identify and resolve the difference.
ACG’s team of professionals is comprised of industry experts with extensive real-world, hands-on experience working in, and with, the organizations operating government health programs including: Medicare Advantage, PDP, Medicaid and Duals, Qualified Health Plans (QHPs), ACOs and provider groups. Our team focuses on institutionalizing compliance throughout health plan operations to enhance efficiency and return on investment.
ACG’s audit specialties include:
CMS Performance Audits, Data Validation Auditing, Third-Party Corrective Action Outcome Validation, CMS Financial Audit Preparation, First Tier, Downstream and Related Entity Monitoring and Auditing, QHP Compliance Auditing, Development of Internal Monitoring, Auditing and Process Controls
Bloom is a dynamic insurance services company that creates specifically engineered solutions supporting the Insurance industry. We are focused on increasing membership and early data collection while reducing costs for Insurance plans. Whether engaging in sales or customer service campaigns, Bloom strives to provide an excellent experience for the caller based on industry best practices. We have submitted over $6 billion in premium and have participated in over 72 million conversations about Insurance since our inception in 2007.
Bloom currently operates two call center facilities in Bloomington, Indiana and is opening a third facility to be located in Phoenix, Arizona in 2016. We are privately owned and currently have around 700 employees.
With nearly three dozen insurance carrier clients and an investment in technology available only at Bloom, we have a turnkey operation and management infrastructure that is capable of executing so seamlessly, it is as if we were part of your organization.
Deft Research is the health insurance industry’s trusted source for relevant market and consumer information. We are committed to helping our clients identify opportunities for innovation and better service and communicate with their members. Our research and guidance supports the nation’s top healthcare brands in making more confident business plans and decisions.
DMW Direct, a direct marketing agency, has actively participated in the evolving world of Medicare products since its inception in 1984. DMW has a rich historical perspective that starts with marketing Medicare Supplements in the 1980s to helping launch the first Medicare Risk products in the 1990s. It has continued to assist health insurance companies nationwide launch and grow their Medicare Advantage and Medicare Supplement businesses.
Using direct response advertising in all media, DMW Direct strategizes and builds marketing programs designed to sell, support, and retain Medicare plan members, producers, and providers.
Welltok, Inc. is a health optimization pioneer transforming the way population health managers partner with their consumers. Welltok Analytics Services leverages learnings from our proprietary consumer database of over 275 million Americans to drive organizational performance including quality of care, member acquisition and retention, operational efficiency, financial performance and risk adjustment.
Beacon Review is a Boston-based company providing Risk Adjustment solutions for health plans and medical groups serving Medicare Advantage members, ACO beneficiaries and Health Exchange enrollees. Our team of health data experts, nurse reviewers, certified coders and physician consultants has been working with providers to improve risk adjustment documentation since 2008. We specialize in chart review, point of care messaging, data analytics, physician education and ICD-9/ICD-10 coding. We offer a personalized approach that incorporates the need for clinical accuracy in both retrospective and prospective review programs. Programs and services are customized to meet each client’s needs.
Babel Health offers the first integrated suite of risk adjustment submission applications (EDPS, RAPS, EDGE Server, Medicaid) for Government-sponsored programs. Our innovative solutions enable payers to increase revenue, reduce operating costs, meet compliance requirements, and improve quality in this complex, dynamic environment.
Babel integrates seamlessly with existing IT applications to provide business users with unprecedented insight, control, and transparency. Our mission is to empower you to take control of your risk adjustment submissions, analytics, forecasting, and reconciliation. The result is less manual work, higher compliance, true insight, and optimized revenue.
Dynamic Healthcare Systems provides comprehensive solutions to health plans and health systems participating in Medicare Advantage, Managed Medicaid, and Marketplace programs. Dynamic’s solutions help its clients optimize plan revenue and quality through the utilization of Dynamic’s rich analytics that identify areas for potential improvement, help maintain compliance through ongoing enhancements aligned with CMS regulations, and enhance operational efficiency through fully integrated solution utilizing a centralized database and integrated workflows. Headquartered in Irvine, California, the company offers comprehensive software solutions, managed services, and professional services. For more information, visit dynamichealthsys.com or call 949.333.4565 ext. 125.
Improve the health of your members and your business with actionable insights from ExamOne Health Solutions, a Quest Diagnostics company. With a suite of tools and solutions that inform early intervention, our comprehensive approach to risk assessment and gap closure can help take outcomes to a higher level. Partner with Quest for innovative ways to complete custom health screenings for a variety of populations, and enable providers to support value-based care with real-time, member-specific data analysis. Learn more at MediCheck.ExamOne.com.