Precision is key: How payers can unlock strategic insights from claims and clinical data integration
Today, payers face mounting pressure to deliver better outcomes, control the cost of care, and manage financial risk. Meeting these goals requires more than access to raw data—it demands actionable insights that support strategic, cost-effective decision-making. This is where the integration of clinical and claims data becomes transformative. By bridging the gap between clinical records … Precision is key: How payers can unlock strategic insights from claims and clinical data integration
The decade of full risk starts now: Four workflows separate ACOs ready for it
The conditions for value-based care (VBC) have just shifted, as stronger financial results, improved data usability, and new long-term CMS incentives reshape what it takes for Accountable Care Organizations (ACOs) to compete and succeed. ACOs have had access to Centers for Medicare & Medicaid Services (CMS) claims data for years. What has made the difference … The decade of full risk starts now: Four workflows separate ACOs ready for it
How to choose the right risk adjustment vendor
Executive Summary Choosing a risk adjustment vendor should never be reduced to coding function alone. The right platform should improve documentation quality, integrate into clinical and operational workflows, provide transparent analytics, support prospective and retrospective programs, and maintain audit readiness. Organizations should prioritize configurable technology, explainable AI, strong governance, measurable outcomes, and an implementation approach … How to choose the right risk adjustment vendor
What is risk adjustment software? A guide for healthcare organizations
Risk adjustment depends on accurate data, complete documentation, and consistent workflows. For healthcare organizations managing risk-based contracts, those requirements can become difficult to coordinate across teams, systems, and populations. Claims data may live in one place, clinical data in another, documentation review in a separate workflow, and reporting in static dashboards or spreadsheets. Risk adjustment … What is risk adjustment software? A guide for healthcare organizations
