MedAssurant applies thousands of proprietary, clinically-driven algorithms within the CARA™ and CARA-Rx™ solutions to identify data which suggests evidence of gaps between existing documentation and that documentation needed to more accurately and comprehensively reflect a member’s HCC, ACG, CDPS, DCG, CRG or other reimbursement factor status. These gaps or incongruences between documented encounter data (used by CMS, state-based, and commercial programs for reimbursement calculations) and data suggesting the existence of chronic, additional, worsening, or more optimally classified disease and comorbid processes are referred to as Clinical Encounter Data Incongruences (CEDI™).

Evidence of unconfirmed diagnosis, worsening disease states, overlooked chronic conditions, procedures, medication prescriptions, diagnostic orders and results, implications of durable medical equipment, V Codes, E Codes, absences of beneficial coding specificity, and coding combinations are but a few examples of categorical analyses that are undertaken by the CARA™ suite. Armed with a broad arsenal of data consisting of both CMS-accepted data and an extensive superset of healthcare data analysis results, CARA™ additionally performs complex, clinically driven chronology analyses to further enable interpretation of disease state progressions, as well as clinical event sequencing and clinical event grouping data – not just at points in time, but rather across pertinent time periods as well.

Beyond patient-driven data impact, CARA™ further recognizes that individual practitioners and clinical environments are unique. Whereas a health plan’s network is often viewed as one whole, in actuality they are constructed of, and highly influenced by, their many constituents – their patients, practitioners, and administrative support staff. Patient demographics, specialty-dominance, disease catchments, and referral patterns all weigh on differentiating the data results that drive reimbursement under state, commercial, and CMS’ risk adjusted models. Additionally, treatment, documentation, and coding styles can vary from practitioner to practitioner, and from practice location to practice location. CARA™ is attentive to these differences. Ultimately, CARA™ utilizes not only available data provided by its health plan clients, but the context of time, location, and practitioners as well – all with a focus on delivering superior results.