ELEVATE! Risk Adjustment Insights

Advantmed’s singular objective is to help our managed care clients optimize revenue and quality.

Advantmed’s ELEVATE! Risk Adjustment Insights analytics engine combines advanced suspecting and targeting, probability trend analysis and coding gap intervention to provide managed care organizations with a comprehensive risk adjustment solution. The revenue optimization process begins with calculation of historical and potential risk scores and determination of suspected morbidities leading to both revenue optimization and cost containment prospects. In addition, ELEVATE! Risk Adjustment Insights interprets risk score trends to outline a client-specific risk adjustment strategy with interventions tailored to each health plan’s unique needs.

ELEVATE! Risk Adjustment Insights is one of the foundational services within the ELEVATE! Healthcare™ platform. By providing real-time access and visibility to the underlying drivers of medical and financial risk, our clients improve payment accuracy, address population health necessities, and rationalize the cost of care provided. The agility of our ELEVATE! Risk Adjustment Insights solution allows clients to analyze risk scores based on specific Hierarchical Condition Categories as defined by CMS for the Medicare, ACA and state-based Medicaid models.

End-to-End Risk Adjustment

  • Fully-managed and flexible solutions – Importing all key health plan data and processing the results through all major risk models
  • Identify non-optimized members due to projected RAF scores or suspected morbidities
  • Intervention Targeting – Identify chase logic methodologies to prioritize medical record retrieval based on claims and/or pharmacy data, demographics and self-reported conditions
  • Agile reporting and data transparency – Monitor the progress of coding assignments and revenue optimization activities in real-time
  • Member and provider engagement – Identify service gaps and documentation gaps from coding services while providing intervention solutions tailored to each client’s goals
  • Medical record retrieval, medical record coding and inferred coding services

Download our ELEVATE! Risk Adjustment Insights brochure