Where We Excel

RISK ADJUSTMENT

With extensive risk adjustment experience across Medicare Advantage, Commercial ACA and Medicaid, we are skilled in building out new programs or turning around existing operations. We have spearheaded machine learning and natural language processing to aide in appropriately assessing and documenting the disease severity of your patient populations. We have supported vendors in achieving 98% coding accuracy and increased risk scores 6% YOY during the pandemic for a large top performing medical group in the Los Angeles market.

Quality reporting

What make us stellar at Quality Reporting is we have significant experience with reporting performance to CMS, NCQA and the Integrated Healthcare Association in California. We are deep in Medicare Advantage, Commercial and Medicaid quality measures. We understand the complexity of the road map, the validation process and much more. We have improved Stars and HEDIS measures by 25%-50% from deep diving into data feeds and EMR extracts.

Accountable Care Organizations

Our expertise in alternative payment models and the Center for Medicare and Medicaid Innovation ACOs dates back to 2012 with the inception of the Pioneer ACO program. We were one of only three ACOs in the country to acheive positive shared savings two years consecutively. We understand the multiple programs including MSSP, Primary Care First, Kidney Care Models, TMaH and others.

Physician Practice Evaluation

While many Big 5 consulting firms have significant resources and are adept at reorgs, we have worked in large health systems and provider offices. We have overseen front-line staff, managed and improved patient scheduling and patient experience, and supported providers in an optimal work experience. We have hands on expertise in claims submissions, provider and hospital contracting, analytics, Stars and HEDIS performance and identifying the appropriate IT infrastructure.

Healthcare turnaround and restructuring