Prospective AdvantageTM
MedAssurant’s Prospective Advantage solution combines advanced health care data analytics with a nationwide infrastructure designed to identify and close gaps in quality, care and documentation. Powered by MedAssurant’s predictive analytics and expansive national data set, Prospective Advantage enables the rapid achievement of meaningful return-on-investment through targeted interventions to improve CMS five-star quality ratings by supporting appropriate patient care. MedAssurant delivers reduced medical expense, improved clinical documentation and improved risk score accuracy.
Aggregate client available data
Proactive care coordination and enhancement starts with data analytics applied to comprehensive datasets. We aggregate information from health plan claims, electronic medical records, prescription, lab, emergency room and hospital admission data, as well as from data provided directly by individual physicians and members to create a more complete picture of the member’s health and diagnoses.
Analyze to identify improvement opportunities
MedAssurant’s clinically-driven algorithms reveal the complete spectrum of risk factor and quality score improvement opportunities across 3,500 disease and comorbid conditions. Our deep analytics identify member-level clinical gaps and inconsistencies across various care settings with greater specificity and less risk than otherwise available. We then evaluate previous care interventions and known risk factors to prioritize overlooked diagnoses and opportunities to improve care and impact return-on-investment.
Inform through ongoing tracking and reporting
In addition to a dedicated expert project management team, MedAssurant provides a comprehensive suite of reporting and analytical tools accessible 24/7 through a secure client-web portal. Clients have ongoing access to the process, results and reporting in aggregate and at the individual member level to guide decision-making and ensure target return-on-investment goals are achieved.
Validate findings and HCC accuracy
Once probable gaps in coding have been identified, health plans must pursue and validate the un-coded, under-coded, or miscoded diagnoses by examining the enrollee’s medical record and securing appropriate documentation of the diagnosis from an approved data source. Our clinically-driven medical record review logic combines proprietary toolsets and clinical alerts to optimize findings while efficiently guiding our nationwide employee network of in-market clinical reviewers to the appropriate documentation. This provides for a streamlined substantiation process where MedAssurant can either integrate results into the health plan’s final submission process, fully submit on behalf of the health plan using CMS-ready Risk Adjustment Processing System (RAPS) or even provision a state-based file document.
Improve risk and quality score accuracy
MedAssurant provides significant return-on-investment results tied to increased risk score accuracy while achieving better quality scores by proactively closing care gaps. Once all affected members have been identified and prioritized, MedAssurant then provides targeted interventions that enhance the provider-patient relationship and ultimately improve quality of care, risk score, and health plan revenue. Comprehensive data analytics examine member behavior to determine and implement the most appropriate specialized support program which can take the form of direct mail, telephonic outreach, transportation coordination or when appropriate, in-home assessment. Going further to enhance the member-provider relationship, we deliver web-based decision-support tools at the point-of-care to help facilitate the member’s encounter with the practitioner.