Redefine patient care, increase revenue, and optimize costs with TheHealthcare360
AI-based Risk Adjustment 360 CRM & Analytics Tool
Our advanced and unique HIPAA compliant tool allows you to manage, analyze, plan, capture, track, and report all aspects of your risk adjustment and risk-sharing programs by utilizing several AI-based integrated modules in one interactive, user-friendly, and role-based platform.
- Our team of risk adjustment 360 subject matter experts (SMEs) has developed their expertise over many years with various health plans and provider groups. They are ready to partner with you to provide the expertise to help run a successful and profitable risk adjustment and risk-sharing programs.
- Our team helps with creating the operational playbook and executive plans for all aspects of the risk adjustment and risk-sharing programs.
- Our team provides guidance and offers unique solutions for the issues that healthcare organizations face.
- Teams of Business Intelligence (BI) & IT professionals bring their rich expertise in healthcare IT to address all your IT needs.
- Our team supports your healthcare IT projects and processes includes but not limited to:
- Structure and design
- Automation and enhancements
- Data and files processing
- Turnkey and in-house projects
- Reporting and analytics
- Our team is HIPAA privacy and security certified.
TheHealthcare360 Product Suite Modules
This member-centric module provides 360° insight about your members. It compares current demographic and health status to historical statuses and predicts future status. This results in better membership management by closing gaps in the member’s healthcare and quality measures.
This module focuses on providers to measure and enhance the quality, completeness, and efficiency of the services provided to the patients. It provides in-depth statistics and analytics to highlight any provider’s gaps and issues and how to resolve it.
The heart of the Risk Adjustment program is the RAF360. The focus is on membership RAF: Defining the current RAF, past RAF, future RAF – what it will be, and what it should be. Our goal is to identify all gaps and predict possible gaps to capture by using complex and validated analytical models.
This module identifies the current quality measures status, identifies the gaps, and provides possible ways to close them which will help improving quality performance metrics. Self-Managed AI-based module that allows you to update your measures status as frequently as needed.
This module includes a clinical coding tool that has automated NLP-based charts and data review processes which allows organizations to capture various data like diagnosis codes, procedure codes, quality measures, and much more.
This module focuses on cash flow and the RA payment models and processes to help organizations identify what likely payment when they should receive payment, and identify any gaps in payments.
This model provides a 360° view of claims. It allows users to slice and dice the complex claims data to provide answers to business questions like utilization, costs, and statistics easily. In addition, it utilizes claims data to get an accurate PMPM and to identify possible ways to reduce it
This model provides a complete picture of submissions. It reconciles what has been submitted with what should have been submitted. Also, it finds the gaps, rejections, and other issues in the submission process then it creates files to submit missing data.