Reduce risk and maintain compliance with AI-enabled solutions
Improve accuracy in code capture, risk scores, and revenue outcomes
The healthcare industry generates immense amounts of data and information. As a result, companies are rapidly turning to artificial intelligence (AI) enabled solutions and partnerships to accurately understand data and information to drive better care outcomes. Incorporating AI-enabled solutions and partnerships provides plans with a true and timely picture of member health conditions and the ability to coordinate better care while improving accuracy.
Health plans and risk-adjusted providers must incorporate both structured and unstructured data into their risk adjustment programs. AI solutions can help. Without including these solutions, plans and providers chance inaccurately representing risk through erroneous and incomplete risk score calculations, lowering confidence in actual and forecasted reimbursements, and reducing funding for member services and care. While structured data is in a standard preset format that is easy to for systems to ingest, unstructured data is more of a challenge. This unstructured data includes essential information available in non-standardized text and objects, making it essential for companies to be able to use. By some estimates, unstructured data makes up more than 80 percent of medical data.1
AI helps revolutionize risk adjustment programs by enabling plans to
Advancements in digital interventions, including AI-enabled solutions, are revolutionizing the healthcare industry and its ability to identify and provide care for at-risk members and patients. EXL’s risk adjustment AI-enabled solutions in combination with risk adjustment expertise are well suited and ready to support plans and at-risk providers to drive performance and innovation, reduce risk exposure, maximize accuracy in coding and revenue, and lessen the likelihood of receiving overpayment using advanced analytics and digital technology.
Reference:
1 https://healthtechmagazine.net/article/2023/05/structured-vs-unstructured-data-in-healthcare-perfcon#:~:text=Most%20healthcare%20data%20is%20unstructured,clinical%20content%2C%20according%20to%20NetApp