Provider
Engagement Solutions

Collaborative workflows for superior clinical outcomes,

health plan performance & member satisfaction

Novillus Solution Suite

Care Gap Management

The Novillus Care Gap Management Application (CGMA) offers our clients a comprehensive integrated solution to drive the provider engagement activities essential to achieving performance goals. The CGMA enables bi-lateral clinical data exchange, year-round data capture and care gap closure, ongoing provider coding and documentation education, and provider performance optimization across Medicare Advantage, Medicaid, CHIP, ACA and commercial lines of business.

Through our engagement expertise, industry experience, and intuitive technology, payer and provider partners drive improved HEDIS®, Medicare Star Ratings, and risk adjustment program outcomes.

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Automated Chart Abstractions

Payer teams responsible for medical chart abstraction typically struggle to keep up with the volume of charts that must be reviewed under relentless schedule pressure. Abstractors must match each chart to each member and their care gaps and then accurately determine if all evidence required to satisfy care gap closure criteria is present.

Novillus uses Natural Language Processing (NLP) – a field of artificial intelligence – to create significant efficiencies for abstractors and health plan operations by automating the process of matching charts to each member, analyzing each chart and identifying whether or not evidence satisfying gap closure criteria is present.

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Incentive Calculations

Calculus is our powerful solution for modeling and managing provider incentive programs in Medicare Advantage, Medicaid, CHIP, ACA and value-based contracting programs. Calculus can calculate provider performance and incentives on a daily basis over a range of different reward programs. Model-building tools help you create and try out “what if” provider incentive reward packages and generate financial forecasts; using Calculus trend analysis you can then tie the actual results back to the forecasts. Calculus makes it easy to manage provider incentive payments via 835 EFT on whatever schedule you choose – annual, quarterly or monthly.

Insights

The Novillus care gap management solution puts actionable, real-time power into the hands of providers. Unleashing these provider actions creates opportunities for faster analysis of emerging trends that directly impact your performance goals.

Insights is the Novillus analytics power tool that compliments the care gap management solution to harness provider actions into clearly understandable visualizations. Armed with decision support information powered by Insights, you’ll be able to take decisive actions to reach or exceed your performance goals.

Clean

Federal regulations for provider directory accuracy in the No Surprises Act became law on January 1st, 2022. Novillus Clean provides health plans with a solution that delivers 100% accurate provider directory information for regulatory compliance. The solution delivers a continuous audit of provider directory data, including which providers are accepting new patients, the provider’s hours of operation, languages spoken, telehealth encounter options, locations, areas of specialty, and much more.

Strategic Consulting
and Support Services

In addition to our innovative technology solutions, Novillus offers client partners strategic support to help them achieve their program and performance goals. Our team of experts come from various health plans across the country with the knowledge and tactical experience to improve performance for HEDIS®, Medicare Star Ratings, Risk Adjustment / Hierarchical Condition Category (HCC) capture, product design, and data quality and architecture. Our team is available to serve on a project basis or as interim full-time support.

Novillus is equipped with a team of certified risk adjustment and HEDIS quality coders to augment health plan resources. Additionally, Novillus has enabled a complete CRM solution with outbound/inbound capabilities to support health plan campaigns and initiatives.

Novillus was founded on the belief that it should be easier for health plans to collaborate with both their partner provider groups and associated members to provide the data critical to driving improved outcomes and optimal health plan program performance. Centered at the intersection of healthcare and technology, Novillus solves complex health plan data interoperability challenges with digital solutions and engagement expertise.

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