Risk Adjustment Analytics

Predictive analytics to optimize revenue

Efficient, Effective, and Flexible Risk Adjustment

Take control of your risk adjustment analytics.

With Risk Adjustment Analytics, gain visibility into and improve the efficacy of your Medicare (MA) and ACA risk adjustment program through advanced analytics. Our complex AI analytic models evaluate undocumented and potentially mis-documented risk, while predicting future risk accurately. This helps reduce costly chart chases, coding reviews, and gap closure activities and optimize the Risk Adjustment program ROI. We also provide objective evaluations of program effectiveness, provider performance, and member outcomes to inform ongoing strategy, leading to positive financial and care outcomes.

Leveraging the nation’s largest commercial claims database, our risk adjustment program empowers clients to identify variations in risks and care gaps at both national and regional levels. Our advanced machine learning engine harnesses the power of behavioral and social determinants of health data, alongside multiple other data sources. By processing over 2,000 predictors, we assist clients in gaining a deeper understanding of the needs and risks within their population, while uncovering hidden population risks.

Using Specialized Analytics VS. End-to-End Solutions

End-to-end solution providers have an incentive to maximize costly gap closure activities. Because we unbundle analytics from interventions, we never recommend chart chases that yield a poor return on investment. At a time when operational efficiency is critical, BHI’s analytics-only approach can save Blue Plans millions of dollars a year.

Risk Adjustment Analytics Advantages:

A comprehensive analytics platform.

Integrates essential methodologies into a transparent, multidimensional data model.

Advanced gap identification models.

Captures hard-to-detect understated risk using advanced analytics and machine learning models.

Actionable provider-centric insights.

Flags providers who may be candidates for outreach and education.

National and regional benchmarks.

Lets you compare risks and care gap variations to regional and national health plan benchmarks.

Transparent, collaborative partnership.

Supports your internal team in growing analytics capabilities by transparently sharing and adapting algorithms and measuring progress.

Flexible integration.

Easily integrates into internal workflows. Results files support actuarial needs, medical record retrieval and review, reviews, in-home assessments, and prospective provider engagement efforts.

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Experience our industry-leading risk adjustment analytics and get answers from our expert consultants.

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