Services
Three disciplines.
One integrated practice.
Performance in value-based care is not siloed. Risk, quality, and utilization interact, and the organizations that manage all three from a unified strategy consistently outperform those that do not.
Risk Adjustment
Close the gap between clinical complexity and documented risk.
HCC analytics, prospective programs, and retrospective review that produce accurate RAF scores, survive RADV audit, and give your organization a defensible documentation foundation, not just a higher number.
- HCC analytics & documentation opportunity scoring
- Prospective gap programs & AWV workflows
- RADV audit preparation & defense
- Coding accuracy assessments
- Clinician education & query workflows
- Retrospective chart review
Risk Adjustment
Quality / HEDIS
Move HEDIS rates that actually move Star ratings.
Gap identification is the easy part. We build the operational infrastructure, outreach, provider enablement, supplemental data, that closes gaps at the rate needed to shift performance tiers.
- HEDIS measure-level gap analysis
- Hybrid medical record retrieval
- Star rating strategy & roadmap
- Gap closure program design
- Provider engagement & EHR integration
Quality / HEDIS
Utilization Management
UM programs that balance clinical integrity with cost performance.
From initial criteria selection to appeals workflow design, we help organizations build UM programs that are compliant, defensible, and operationally efficient, without sacrificing appropriate care.
- UM program design & implementation
- InterQual & MCG criteria application
- Prior authorization workflow
- Peer-to-peer & appeal support
- CMS / NCQA compliance alignment
Utilization Management
Not sure which service fits your situation?
We'll help you identify where the gap is, and what will close it.