Maximize analytic insight and streamline year-round risk management processes

Risk adjustment and quality metrics are progressively driving accountability and profitability across the healthcare system, making metrics-based transparency more the rule than the exception. Health plans and providers need to develop strategies that project risk-based reimbursement and quality-driven payments and penalties. Mining your existing data – and applying advanced analytics and predictive models – is a smart place to start.

Pulse8 is the only healthcare analytics and technology company delivering complete visibility into the efficacy of your risk adjustment and quality management programs. Pulse8 enables health plans and at-risk providers to achieve the greatest financial impact in the Health Insurance Marketplace, Medicare Advantage, and Medicaid markets.

By combining advanced analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment and quality metrics. Pulse8’s flexible business intelligence tools offer real-time visibility into member and provider activities so its clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality.

Working together, GHG and Pulse8 will further support health plans and at-risk providers with managing increased quality mandates and achieving payment accuracy while introducing new technology solutions to maximize analytic insight and streamline year-round risk management processes.

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Why Pulse8

Risk Adjustment Analytics

Pulse8 combines the most precise, confidence-adjusted risk adjustment algorithms with the most efficient gap closure methodologies. Reveal8 optimizes your risk-adjusted returns by mining the hidden opportunities in your data and applying advanced predictive analytics to recommend the right intervention at the right time with the right provider in order to maximize gap closure rates.

Financial Reporting

Pulse8 empowers risk adjustment and revenue management leaders to make data-driven decisions on intervention strategies to ensure accurate reimbursement, optimal resource deployment, and coordination between revenue and quality management. Calcul8 is the ultimate tool for accurately projecting the Risk Adjustment Factor (RAF) points, Hierarchical Condition Categories (HCCs), or Condition Types needed to achieve budget and the intervention type, level, and timing with which to get there.

Risk Mitigation

Pulse8 guards against the financial consequences of data validation audits by revealing risk factors which cannot be validated in the medical record and providers who are not documenting and coding properly. Detector8 looks at conditions with the greatest risk of failing a Risk Adjustment Data Validation (RADV) audit, and assesses the strength of the data supporting each condition and the financial exposure associated with each.

Quality Analytics

Pulse8 prioritizes and directs gap closure efforts for CMS Star Ratings, the Affordable Care Act (ACA) Quality Rating System (QRS), and Medicaid quality measures through predictive analytics and dynamic intervention planning. Qualit8 functions as the quality command center, helping our clients to identify and prioritize the quality gaps most worthy of attention.

Provider Engagement Support

Pulse8 helps risk-bearing entities to collaborate with their provider networks, using an approach which minimizes provider abrasion and network disruption. At the heart of Collabor8 is a self-service portal for delivering member-specific “provider alerts,” a series of analytic dashboards for managing the process, and field services for educating providers about effective documentation and coding.

Electronic Medical Record (EMR) Integration

Pulse8 works with the leading EMR vendors to help payors and providers share data more efficiently, communicate more effectively, and address the myriad of quality measures more completely. Integr8 unites leading EMR systems with our Reveal8 engine to enable the bi-directional exchange of data: Integr8 embeds advanced analytics into the provider’s workflow and extracts patient data from the provider’s EMR.

Coding Technology

Pulse8 leverages advanced technologies to produce the most efficient and accurate solution for identifying, documenting, and coding your members’ conditions. Productivity gains of 40 percent are readily achievable through the use of Popul8, our computer-assisted coding engine that pre-populates charts and produces an efficient workflow.

Submissions & Reconciliation

Pulse8 ensures accurate, timely, and complete EDS/RAPS and EDGE Server submissions with a scalable, flexible, and integrated solution. Reconcili8 is flexible enough to accommodate custom business rules and versatile enough to support the specific regulations, format changes, and workflows of the Health Insurance Marketplace, Medicare Advantage, and Medicaid markets.

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