Risk Analytics

Medicare Advantage (MA) Analytics

Why EMSI Health

In order to experience continued successful performance, health plans need current, meaningful data about their member population. As your partner, EMSI Health has the experienced staff and proven performance to provide complete risk analytics for your MA membership.

How It Works

EMSI Health offers industry-leading data analytics that provide health plans with comprehensive information about their member population. Our member-targeting approach for chart review and examinations is based on persistence, statistical analysis and clinical rules. First, we identify previously identified conditions in succeeding years to ensure they continue to get captured for risk-adjustment and care management purposes. Second, we compare the change in RAF from chart reviews and Healthy House Calls with the CMS-HCC risk model, CMS-HCC hierarchies and CMS-HCC interactions.

Our statistical analyses, based on regression models relating the existence of prospective and retrospective HCCs, diagnosis and prescription drugs to the change in RAF, are a critical component of the ROI analysis.

Our clinical rules identify members based on numerous industry standards, as well as target onset and progression of disease related to the CMS-HCC risk model.

Our in-depth analysis utilizes pharmacy, physician and facility claims data, which includes critical information such as diagnosis codes, procedure codes, place of service codes, lab data, radiology data, NDC codes and drug classification related to acute and chronic disease states.

Our sophisticated analytic capabilities enable us to make intelligent decisions about additional information to include in our reports. For example, we often include obvious chronic conditions with significant odd ratios, because we know that in spite of the odds, clinical judgment indicates they should be captured.

Our member report card profiles are complete with actionable measures and outreach opportunities for appropriately ranked and quantified members, allowing you to make determinations as to which member to contact and when.

Learn more about what we can do to help you prepare for and succeed with your risk-adjustment initiatives for MA members. Contact us today.

Health Insurance Marketplace Analytics

Why EMSI Health

In order to experience continued successful performance, health plans need current, meaningful data about their member population. As your partner in navigating healthcare reform and the health insurance marketplace, EMSI Health has the experienced staff and proven performance to provide complete risk analytics services based on your specific needs.

How It Works

EMSI Health offers industry-leading data analytics that provide health plans with comprehensive information about their member population. Our member-targeting approach for chart review and examinations is based on persistence, statistical analysis and clinical rules. First, we identify previously identified conditions in succeeding years to ensure they continue to get captured for risk-adjustment and care management purposes. Second, we compare the change in RAF from chart reviews and Healthy House Calls with the CMS-HCC risk model, CMS-HCC hierarchies and CMS-HCC interactions.

Our statistical analyses, based on regression models relating the existence of prospective and retrospective HCCs, diagnosis and prescription drugs to the change in RAF, are a critical component of the ROI analysis.

Our clinical rules identify members based on numerous industry standards, as well as target onset and progression of disease related to the CMS-HCC risk model.

Our in-depth analysis utilizes pharmacy, physician and facility claims data, which includes critical information such as diagnosis codes, procedure codes, place of service codes, lab data, radiology data, NDC codes and drug classification related to acute and chronic disease states.

Our sophisticated analytic capabilities enable us to make intelligent decisions about additional information to include in our reports. For example, we often include obvious chronic conditions with significant odd ratios, because we know that in spite of the odds, clinical judgment indicates they should be captured.

Our member report card profiles are complete with actionable measures and outreach opportunities for appropriately ranked and quantified members, allowing you to make determinations as to which member to contact and when. Contact us today.