REPURPOSE:

Improve Healthcare Efficiency by Identifying Gaps In Care

Eco-Scaling™ encourages the enterprise-wide use of healthcare data for multiple purposes. Outcomes Health’s methods facilitate the identification, aggregation and repurposing of patient-centric data. This makes possible the transformation and mapping of claims or encounter data from disparate sources in various formats. This process improves healthcare efficiency and helps organizations identify gaps in care.

By repurposing harvested information from claims, encounter data and health records, work can be leveraged from one project and optimized for data analysis needs for an entire organization to improve healthcare efficiency.

Through its suite of data analytical capabilities, Outcomes Health produces actionable data sets that help reduce gaps in care. There are multiple uses for improved and repurposed data, including:

Payment Integrity Auditing (PIA™). This line of service includes:

  • CMS HCC Risk Adjustment – “suspect identification” or chart identification for prospective and retrospective activities
  • Medicaid Payment Compliance Audits
  • Evaluation & Management Audits
  • RADV (Risk Adjustment Data Validation) Audit Support
  • ER audits
  • DRG / MS-DRG Audits

 

Health Outcomes Improvement (HOI™). Outcomes Health can deliver:

  • HEDIS® Data Collection and Reporting
  • Provider/Group Level Outcomes Health Reporting
  • State and Federal Quality Reporting Initiatives
  • Drug Safety and Efficacy Studies
  • Disease Specific Audits
  • Accreditation Audits
  • Credentialing Audits and Site Surveys
  • Customized Data Collection and Audit Projects

 

Health Advocacy Programs (HAP™). This type of member outreach service includes:

  • Three-way Call, Provider Appointments
  • New Member Welcome Programs
  • Health Risk Assessments
  • Member Retention/Member Re-certifications
  • SNP Programs and Initiatives
  • ER Follow-up Assessments
  • Prevention and EPSDT Outreach
  • Disease Management Support Services
  • HEDIS® Member Outreach
  • Care Gap Outreach
  • Health Care Reminder Calls
  • Customized Member Outreach Programs

 

Outcomes Health sorts the inconsistencies, corrects data inaccuracies, analyzes the results and improves the data.We call this Eco-Scaling™.