Payer Goals: Accuracy, Compliance, Collaboration
Every health plan faces the same fundamental challenge: capturing accurate risk while maintaining CMS compliance and fostering productive provider relationships.
Risk Accuracy
Ensure complete and accurate documentation of member conditions to reflect true health status and appropriate risk scores.
CMS Compliance
Meet regulatory requirements with audit-ready documentation and RADV-validated diagnoses that stand up to scrutiny.
Provider Collaboration
Enable seamless data exchange and insights sharing to align payer and provider goals in value-based care arrangements.
Prospective Insights for Member Management
Identify risk gaps before they become revenue gaps with proactive member risk stratification and care opportunity insights.
Member Risk Insights
Comprehensive member risk insights powered by Whole Person Risk Scores. Prospect360 enables seamless payer-provider communication through our collaboration portal, sharing care gaps and HCC opportunities directly with provider networks.
- Whole Person Risk Score for complete member view
- Comprehensive member risk insights and stratification
- Payer-Provider Collaboration Portal
- Pre-visit care gap sharing with providers
Retrospective Analytics for Audit Readiness
Validate submitted diagnoses, identify documentation gaps, and ensure every claim is audit-defensible.
Audit Optimization
End-to-end retrospective audit strategy, planning, execution, and monitoring. Retro360 delivers predictable financial forecasting visibility and transforms RADV compliance into a competitive advantage.
- Retro Audit Strategy and Planning
- Audit Execution and Monitoring
- Predictable Financial Forecasting visibility
- RADV-ready documentation validation
How Payers Partner with Providers Using Analytics
Bridge the gap between health plan objectives and provider workflows with shared analytics that drive mutual success.
Claims Processing
Process and analyze claims data to establish baseline member health profiles and payment accuracy.
Build Risk Insights
Build cumulative risk insights and identify care gaps from historical claims and clinical data.
Share via Portal
Share risk insights through the collaboration portal, connecting payers directly with provider networks.
Pre-Visit Planning
Enable providers with member-specific care opportunities and HCC gaps before scheduled visits.
Validate & Close
Confirm diagnosis capture and measure the impact of collaborative risk adjustment efforts.
Explore Payer Products
From prospective member insights to audit-ready retrospective validation, explore our complete payer risk adjustment analytics suite.
Prospect360
Member Risk InsightsProspective member risk insights for proactive care management and accurate risk capture.
Explore member risk insightsRetro360
Audit OptimizationRetrospective audit optimization for RADV readiness and documentation validation.
Explore retrospective audit optimizationRADV Scrubber
Compliance ValidationPre-submission diagnosis validation to minimize audit exposure and protect revenue.
Explore RADV scrubberReady to Transform Your Risk Adjustment Strategy?
Discover how VBC Risk Analytics can help you drive accuracy, ensure compliance, and enable meaningful provider collaboration across your Medicare Advantage programs.
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