Availity simplifies quality and risk adjustment workflows between health plans and providers

Availity, a real-time health information network, announced that it launched an innovative risk adjustment workflow solution for digital payer and provider collaboration. Revenue Program Management 1.0 (RPM) attacks the inefficiencies and frustration currently associated with gathering and managing quality and risk related information about patients.

As health plans work to improve the timeliness and accuracy of healthcare condition information for accurate coding, quality data for physician alignment and member care coordination, multiple representatives on their behalf often visit a single provider’s office seeking the same medical information. This causes poor data acquisition at a high cost for health plans and frustrates providers.

“With RPM 1.0 we’re digitizing the data collection process by engaging providers in their current workflows, where they already utilize the Availity network,” said Trent Gavazzi, Senior Vice President and Chief Technology Officer of Availity. “Our RPM solution dramatically transforms the way medical information is collected, bringing value to health plans, providers, and patients. We envision a future where retrospective chart chasing goes away, as we digitize these processes into the plan and provider workflows.”

Florida Blue, is the first to partner with Availity on its Revenue Program Management solution.

“Providing timelier, higher quality data in a less intrusive way benefits everyone,” said Juan Chaluja, Vice President of Revenue Program Management at Florida Blue. “Gathering accurate coding information in today’s environment often involves a high-touch and expensive process that can also be disruptive to provider practices. As with Availity’s other services, the RPM solution offers a new digital risk adjustment experience that will proactively help alleviate key pain points in the industry.”

Availity’s RPM solution gathers pertinent medical information that is translated into dashboards for health plans to identify risk adjustment opportunities. Additionally, RPM can be configured to integrate with a health plan’s proprietary or third-party analytics solutions. Those plans that are already fully integrated with Availity’s platform capabilities will see the greatest benefit.

analytics, Availity, coding, Florida Blue, Revenue Program Management, workflow


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