Why We Are Different
Our unique name comes from the term “Population Health Management,” and our highly skilled staff has been involved with Medicare risk adjustment since 1999. With our rare combined expertise, we are able to offer services that are both flexible and innovative. Accurately and quickly, we are capable of performing Medicare Advantage risk adjustment optimization methods, analysis of data, RAPS reporting and submission, financial reporting, revenue management, coaching and consulting, and other vital services for the Medicare industry. We pride ourselves in providing services and developing solutions that are uniquely suited to each client and specifically addresses each client’s needs. Our main interests remain in the long-term success of the Medicare Advantage program along with the overall improvement in the care of high-risk populations.
With the quickly rising number of individuals seeking Medicare Advantage plans, risk adjustment is more important now than ever for health plans, providers, and others involved in Medicare. As specialists and leaders in Medicare risk adjustment, we believe that applying innovative methods for managing high-risk patients are essential, and that the risk adjusted payment system of Medicare Advantage is the key to unlocking that innovation. By offering expert management to organizations engaged in improving care for the populace, we are able to promote the advancement of high-risk patient management, and improve overall performance of health plans.
Based in Arizona, we have extended our business across nine states and Puerto Rico, and we are the ACAP (Association of Community Affiliated Plans) vendor of choice. We are dedicated to helping our clients improve their performance, and strive to maintain a close relationship with each one.
Key Areas That Differentiate PopHealthMan:
- PopHealthMan offers an integrated solution rather than one that is focused primarily on software, chart reviews, or prospective physician interventions.
- The PopHealthMan medical record review process has minimal impact on physician practices and is widely accepted and approved. Chart reviews are consistently scheduled to achieve maximum return for minimal administrative effort.
- PopHealthMan fees are not based on contingency – this practice limits plan payment and reduces potential disputes with health plans.
- PopHealthMan “finds” are based only on incremental HCCs captured for a health plan – impact of the group is not overstated.
- Data analysis tools go beyond simple claims analysis. Process data flows are reviewed and potential gaps are investigated.
- Physician intervention tools are available including member outreach listings, visit aids, etc.
- Adhoc data analysis is provided at no extra charge.
- Most importantly, PopHealthMan offers more flexibility than other vendors. The unique experience and skills of the group allow the team to fill in gaps of the health plan’s existing systems, complementing and reinforcing the processes of the health plan.
