Care Gap Management
Novillus is your experienced partner providing the technology and provider engagement expertise to help you manage the ‘care gap’ lifecycle and optimize outcomes for your population health, Medicare Star Ratings, Medicaid and Risk Adjustment programs. Our payer-specific, customizable care gap management solution helps you identify opportunities and close member care gaps.
Key Outcomes Include:
- Increased engagement with independent and provider-employed physicians
- Improved care delivery and workflow models that align incentives and reduce care costs
- Improved provider and member satisfaction
- Enabled population management tools and services at the point of care for multiple populations
- Educated provider network with varied readiness for accountable care
- 4+ Medicare Star Ratings for health plan partners
Care Gap Management
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 reach or exceed your performance goals.
Provider Directory Accuracy
Our provider directory information accuracy solution, Novillus Clean, will quickly and efficiently power your provider directory with 100% accurate data. We use an innovative combination of provider group engagement best practices, direct marketing expertise, data hygiene methodologies, research and verification—all developed over years of acquiring and maintaining accurate provider directory data to ensure your provider directory is compliant with Federal regulations in the No Surprises Act associated with the Consolidated Appropriations Act of 2021.
A recent health plan audit highlights the provider directory data accuracy problem:
43% of providers were not participating in the health plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed
50% of the dermatologists were duplicates and only 26% of the total were at the listed address, accepted the members from the plan, and had available appointments
Our Clean solution platform makes implementation straightforward, fast and secure. We can have you compliant in weeks rather than months.
Fully Managed Turnkey Solution
Novillus Clean is a fully managed, flexible, turnkey solution directory data solution that provides 100% continuously verified provider data. We will ensure that your provider directory data is accurate and up-to-date to meet Centers for Medicare and Medicaid Services (CMS) compliance requirements. We manage the entire cleaning process for you, freeing up your health plan resources to focus on other priorities.
Focused On Provider Data
Unlike traditional data services that try to cater to many vertical data needs, we are singularly focused on delivering the most accurate and up-to-date provider directory data possible.
We don’t scrape data or buy it from 3rd parties. Our unique, innovative process gets accurate data directly from the source: provider contacts. And we have the feedback data to prove that providers actually enjoy the experience.
Great Provider Experience
Our solution gives providers an elegant, simple, fast user experience during the outreach process for provider directory data updates. And we have the provider feedback metrics to prove it. This has a measurable, positive benefit to your plan’s brand.
Accuracy You Can Count On
Novillus Clean delivers accurate, continuously verified provider directory data through a combination of industry best practices, direct marketing expertise, leading data hygiene methodologies, research and verification—all developed over years of acquiring and maintaining provider directory data.
Understanding and documenting all the practitioner and provider group relationships in the real world is very challenging. Providers and their relationships to one or more provider groups – all the site locations – and the hours of operation at each location can be very complex. And these relationships can change often. Our innovative process obtains and maintains accurate information on these complex relationships that cannot be matched by other solutions.
Easy To Integrate
Our leading-edge solution platform, web services and configurable data management capabilities makes data integration to your provider directory straightforward, fast and secure. Ease of integration is one of the key reasons that Novillus Clean can have your provider directory compliant in a matter of weeks rather than months.
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.
Calculus is a powerful tool for modeling and managing provider performance 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.
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.
Learn how we helped a large health plan exceed their revenue capture targets with our Automated Chart Abstraction solution by requesting a case study.
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