1. Do you offer a supportive relationship rather than a transaction?
Having the same goals as your vendor/partner is a key component to success for your organization. Vendors who are transaction-oriented may have financial interests that are not aligned with yours. For example, you may come across some vendors who, in addition to providing data and risk adjustment analytics, also provide intervention services. In these cases, the analytics these vendors supply can become rationalizations for the often expensive, and sometimes unnecessary, interventions they recommend. At Veradigm, we do not have a vested financial interest in the number and mix of interventions health plans undertake. Our goal is the same as yours — to conduct the right number and the right types of interventions — no more, no less.
2. Do you offer full customer support across all products?
For a healthcare analytics and technology company to be successful, it must take the needs of its customers seriously. The analytics we provide often require a depth of subject matter expertise to understand. Some in the healthcare analytics and technology marketplace charge adjustable rates for their solutions and often take an a la carte approach to their support. It is not uncommon to see variable pricing for implementation, training, data services to name a few.
3. Do you prioritize accuracy and transparency in the analytics you provide?
Many healthcare analytics and technology vendors will tell you they prioritize accuracy, but some may have a more difficult time proving they prioritize transparency. It is important that these two key elements to success work together to effectively manage health plan risk adjustment and quality programs. For example, some in the marketplace will provide a list of gap closure opportunities to target. While you may receive accurate output data at the dashboard level, you are not receiving any granular, member-level details, confidence values, financial value of gaps, or the value of the gaps combined, all of which are critical in making closure decisions.
4. What data do you share with clients to help them make decisions?
The answer to this question will often tell you how great a priority transparency is to the vendor you’re speaking with. The deeper the level of data provided, the greater the importance transparency is to that vendor. At Veradigm, we make recommendations and provide confidence levels through output files, dashboards, and target lists where members and conditions can be targeted for successful Dynamic Intervention Planning. Our clients are empowered to drill down to the source data behind the visual dashboards and invite them to compare the source data to validated, internal numbers. All data we generate for our customers is available for the health plan to conduct their own special studies and manipulate in any way that suits their business needs.
5. What experience do you have in all lines of business, particularly Medicaid?
Health plans know that each line of business (LOB) has its own nuances. Therefore, one-size-fits all solutions are not ideal. The experts at Veradigm contribute clinical perspectives in addition to hands-on risk adjustment, quality, and pharmacy management experience working for health plans in all LOB including Medicaid, Medicare Advantage (MA), Affordable Care Act (ACA), and commercial payers.
6. How precise is your suspecting logic and what files do you use to facilitate suspecting?
Precise suspecting helps generate greater precision analytics. At Veradigm, we use both broad and deep data files to facilitate suspecting. At minimum, on the input side, we are looking at medical and institutional claims data, lab results, and both mail order and retail pharmacy data. Once we have the data, our suspecting algorithms are cutting edge, finding more conditions than our competitors. And, when checking our results against already proven data we see far fewer false positives than other vendors. What’s more, our suspecting algorithms typically find around 90% of the all the hierarchical condition categories (HCCs) in member charts
7. How can you support us with our interoperability goals?
Interoperability is the goal for many health plans, clinicians, and other healthcare stakeholders. It enables timeliness, accuracy, and completeness of treatment so that patients receive higher quality care. By focusing on interoperability today, your organization will be in a better position to transition to value-based care models tomorrow.
8. Are you equipped to understand how we’re using our analytics today and how we want to use them in the future?
Maintaining a tight-knit relationship with clients should be one of the primary goals of any healthcare analytics and technology vendor. This supportive partnership approach allows for a deeper understanding of how clients use our insights today and provides a strong base from which to grow in the future.
Have more questions than the eight we’ve covered here? We want to answer them all! To learn more or get connected with a Veradigm expert contact us at [email protected]