Invent Health MAP

Invent Health’s risk adjustment platform, MAP (Modular Analytical Platform) is a modular platform capable of intaking multiple data formats and providing a real-time analytics engine by normalizing several data sources and running them through proprietary AI/ML algorithms to provide out of the box risk analytics for ACA, MA and Medicaid.

Invent Health’s modules not only create highly accurate reports which have been vetted by multiple algorithms, but they also break down data that could be easily fed to provider groups (PPGs) and providers in a GUI format so that the next best action is possible on a real-time basis.

Invent Health creates an effective workflow between payers and providers where gaps in risk scores, chart chases, annual wellness visits, and prospective and concurrent coding are all cyclically connected until the gaps have been addressed across the payer and provider ecosystem.

Key Features of Invent Health MAP

Invent Health’s goal is to invest in our partners’ successes. Through our MAP, we can do just that. Either through eye-opening analytics and crucial reporting or full-on participation in developing a new, inventive risk adjustment program with provider groups, Invent Health is here to guide the way.

Invent Health provides the optimal level of interventions and targeting to protect your risk adjustment dollars. Our collaborative approach and tools provide instant and immediate visibility into your program’s performance driving optimal financial outcomes while reducing interventions and retrospective chart reviews to produce a negative impact on your risk scores.

360-degree view for both members and providers to drive insights and close member gaps

Using a combination of co-morbid conditions, the provider coding patterns, and the ML (machine learning) based algorithms help identify high-risk members for care and intervention.

Individual provider-level access so each provider can look at specific member data and possible gaps in their information including coding gaps, utilization patterns etc.

The program understands the impact of socio-economic conditions, the impact on risk scoring, and utilization of avoidable services.

Predictive models provide insights about member/provider risk scores and the potential of acquiring new chronic conditions.

Incrementally reduce gaps every year by using machine learning models to identify data patterns and fix HCC gaps at the source.

Comparison Options

The MAP performs risk adjustment reconciliation processes that allow health plans to compare the projected risk scores versus the actual ones, as well as provide concise data of members with risk score discrepancies. MAP also prioritizes data submissions, chart chase recommendations, and the effective closure of gaps.

The process of comparison includes intaking CMS reports, MAO004, and MOR data along with member preventive services such as annual wellness visits, quality metrics screenings, and provider chart review data for analysis. MAP then reports the discrepancies, prioritizes the data, and compares provider performance and risk score opportunities.

Maximum performance through our proprietary cyclical process enabled with actionable workflow:

All the reports and analytics are powered by Invent Health’s proprietary data science techniques which allow health plans to analyze and extract meaningful data insights.

Some of the key metrics that we compare and analyze across all lines of business are as follows:

As part of the user interface (UI), there are various enabled reports to manage the risk and quality opportunities effectively.

The following are some examples:

Health Plans, IPAs, and Provider Groups

Revenue Projection

Financial Forecasting – Invent Health’s MAP provides an out-of-the-box ability to forecast the potential revenue increase for the next year and enable planning and target-setting for the risk adjustment function.

The process computes accurate risk scores based on the initial, middle, and final years, respectively, along with concise data breaking down expected risk scores versus the actual ones.

This creates a high return on investment for providers from a risk adjustment perspective.

The Invent Health revenue projection process includes visibility for all of the KPI metrics that drive risk scores and opportunities for gap closures and future risk score/revenue projections. The platform provides:

A population-level view of estimated and actual risk scores along with opportunities of gap closures
Executive forecasting dashboards that report current, trending, and available opportunities for risk scores.
Prioritization of all gap closure opportunities recommends optimal intervention strategies to close each coding, documentation, and encounter data submission gaps.

Provider care gap closure support: The Invent Health platform supports the most efficient ways of supporting provider outreach and the process of care gap closure. The process runs algorithms for finding and sizing risk adjustment opportunities, as well as revealing and validating health conditions.

It does so by running across state/CMS published risk algorithms such as HCC and CDPS. The system flags all conditions that are reported in previous years via medical claims or through pharmacy prescription drugs and makes recommendations based on this data.

Invent Health provider performance dashboards measure performance KPI results with compelling data.

Invent Health generates actionable data for health plans and provider partners to assess revenue impact and potential areas for improvements:

An increase/decrease in average RAF score and HCC recapture rates.
An Increase/decrease in annual wellness visit rates
An increase /decrease in the percentage of persistent condition diagnoses reported year over year.
HCC gaps closed through prospective and preventive visit programs