Leveraging its extensive healthcare datasets, leading analytical prowess, and nationwide clinical personnel, MedAssurant brings an unparalleled set of synergistic toolsets to bear for its clients. Solution suites driven by years of healthcare market experience, key physician input, leading-edge technology, and a constant attention to its clients’ business, quality, and financial pressures all come together to power MedAssurant’s value-added tools for the analysis of physician performance, market and demographics metrics, clinical outcomes, case utilization, risk adjustment, disease management, fraud and abuse, and many other vital needs of today’s healthcare marketplace.
Due to the comprehensive nature of fraud, waste, and abuse data and analysis processes, the implementation of MedAssurant’s Claims Integrity™ solution lays the groundwork for significant synergies with a portfolio of clinical quality and outcomes assessment, disease management, risk adjustment, business intelligence, and financial performance improvement solutions.
Quality Assessment, Pay-For-Performance, HEDIS®, and Comparative Effectiveness Solutions
For clients needing to perform quality outcomes analysis, pay-for-performance initiatives, or NCQA HEDIS quality measure analysis, MedAssurant provides the nation’s leading end-to-end outcomes analysis tool suite known as the Quality Spectrum Insight™ Complete Quality Management (or CQM™) solutions portfolio.
Whether seeking to achieve internal initiatives, or fulfilling reporting requirements for NCQA, CMS, or state regulatory bodies, MedAssurant’s CQM™ quality outcomes platform integrates seamlessly with the Claims Integrity™ fraud, waste, and abuse solution delivering valuable synergies and cost savings through the coordination of data processes and medical record review initiatives.
Quality Improvement (QI) outcomes analysis, Health Economics Outcomes Research (HEOR), and Comparative Effectiveness Research (CER) toolsets further allow MedAssurant Claims Integrity™ clients to maximize quality, effectiveness, and financial performance impact. Whether seeking to identify areas for care management improvement, or looking to make efficiency and outcomes improvements in pharmaceutical formularies, the healthcare dataset analysis that is core to Claims Integrity™ lends significant benefit opportunity to MedAssurant’s clients.
Disease Management
Another solution lending great synergy and value to MedAssurant clients is SmartCare™, an advanced generation care coordination, decision support, and disease management suite that delivers a highly targeted and granular disease management capability with superior benefits to quality of care, clinical outcomes, documentation compliance, results transparency, and financial performance. Applying a proprietary process of highly targeted and granular patient disease identification, stratification, and prioritization, SmartCare™ implements an unprecedented ability to direct patient-specific disease solution resources with exceptional precision while also serving to improve and benefit from data accuracy and risk score improvement.
Risk Adjustment
Today MedAssurant provides the most widely utilized capitation risk adjustment solution. From Medicare Advantage (MA) plans utilizing the HCC and HCC-Rx risk models, to managed Medicaid and commercial implementations of CRG, ACG, CDPS, DCGs, and other reimbursement models, MedAssurant is uniquely adept at the analytical processes needed to identify and substantiate gaps in risk score amongst enrollee members and implementing solutions to effectively resolve data and documentation gaps to achieve appropriate financial reimbursement benefits needed by today’s health plans. In addition to the immediate financial benefits are quality, bid support, and forecasting benefits, all of which can be gained synergistically for clients of MedAssurant’s Claims Integrity™ solution.
End-To-End Solutions
From quality outcomes analysis and targeted disease management, to MedAssurant’s dynamically informed health risk assessment (HRA) solution, and from fraud and abuse solutions to the acceleration of positive ROI for electronic medical record systems, clients of MedAssurant can gain not only significant operational implementation and cost efficiencies, but also can apply a broad arsenal of coordinated solutions that deliver market-leading results in achieving healthcare quality, care management, and financial performance improvement.