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Enhancing the Abilities of Healthcare Sector Blogs
Enhancing the Abilities of Healthcare SectorOSP’s team of experienced healthcare experts offers quality healthcare consulting services for providers and health plans. Our team includes experts on enterprise software platforms, US government programs, digital innovation, and business operations.
Learn More HearOSP is proficient and experienced in building robust enterprise applications to address your complex and sophisticated software needs and execute your digital transformation lifecycle. We have comprehensive customized tools to solve your healthcare challenge.
Learn More HearOptimizing the healthcare system is essential for better productivity and quality performance. OSP’s team of developers can enhance and upgrade the healthcare solutions in modules, security, or interoperability sections with new custom components.
Learn More HearOSP’s QA team can resolve the challenges of disrupted workflow and application safety. We offer assurance in product quality with multiple levels of quality testing, including usability, performance, localization, and security testing.
Learn More HearOSP’s healthcare risk management offers seamless integration of all the essential solutions in the gamut of liability management. We deliver standalone risk adjustment solutions that drive strategic growth by providing the ability to anticipate, assess, and minimize potential risks. Through our customized healthcare risk adjustment software solutions, healthcare organizations can easily find, decipher, and monitor residual risk score trends and related metrics like average risk scores, expected risk scores, and more. Our risk adjustment solutions can Identify risk adjustment factor score gaps and prioritize healthcare resources used for liability adjustment activities. Navigate your way to a risk-free organizational atmosphere with solutions that are as beneficial as they are easy to use.
Another dynamic feature of OSPs healthcare risk adjustment software solutions is risk targeting – a portfolio allocation strategy that tries to have the same portfolio volatility in every market environment. Gain access to advanced risk analytics tools that offer comprehensive risk assessment and management capabilities. With the healthcare transition to population health management, the healthcare landscape has revolutionized to identify high risk and cost patients. Our medical risk adjustment solutions identify likely candidates for care management programs through comprehensive risk targeting through strategies such as pre-screening of patient outreach. Our solutions are tailor-made to create risk-adjusted algorithms to accurately predict the future costs of patients, their current status, and also patient eligibility for care management.
Self-generate custom liability analytics and access flexible risk reports, score summary, payer and provider targeting, diagnosis history, and payment summaries. Assess potential risks and counter the system’s liability gaps to manage cost reductions and patient payment challenges effectively. OSP is committed to undertaking healthcare risk management by collecting relevant medical records, enabling coding individually and accurately, and, thereafter, delivering sound results. Through healthcare risk management, we enable customized provider-sensitive processes to create beneficial associations with providers. Our flexible reporting solutions reduce manual processes, are comprehensively HIPAA-compliant, and secure enough to carry medical data. Healthcare organizations can adjust risks based on reports that can be generated at regular intervals.
Gain access to analytics support for decision-making and file creation for RAPS submission and EDPS coding project submission. Ensure compliance with myriad health regulations across multiple geographies within cost and time restrictions. OSP’s custom made risk solutions offer the capability to create a consolidated and detailed view of liabilities and compliance across the entire organization. Through the incorporation of advanced analytical technologies, our reach goes beyond organizational data to access and analyze patient, demographic, and specialist avenues of the healthcare industry that will aid in providing a holistic picture of the liabilities and risk vulnerability. Based on the organization’s specific needs in question, we create primary and supplemental analysis to nullify risks at every level and assist with lowered risk scores.
Identify members with possibly undocumented suspect conditions that are appropriate for prospective and retrospective targeting. Link assessed risks to causes, events, dangers, and other elements of governance, risk, and compliance. Implement the customized risk adjustment parameters and navigate through the risk analytics metrics to monitor the potential liabilities. Identify the undocumented HCCs within targeted medical records using powerful, intuitive, and configurable risk adjustment analytics solutions. OSPs risk adjustment solutions are designed to aid a healthcare organization to create a suspect list toward optimizing revenue. This is executed by a detailed analysis and examination of patient data and using predictive analysis to arrive at sound conclusions. This is enabled through complex pattern recognition tools that are more likely to be accurate than traditional manual methods.
OSP specializes in the transition of manual processes to automated risk adjustment solutions that include health plans, exchanges, member medical record data, and supported reimbursements through Electronic Medical Record (EMR) solutions. This eradicated complex and time-consuming procedures of emails, faxes, and couriers for documentable data. With agile retrieval methodologies that can achieve maximized goals, our solutions are customized toward efficient resource utilization, reduced turnaround time, and minimal complexities for providers. Above retrieval, we undertake provisions for aggregation, indexing, and storage or medical records, which can be used for holistic analysis. Through our high power algorithms, we extend the capacity of a healthcare organization to achieve their risk adjustment targets with minimal effort, downtime, and complete transparency.
Charlie LangdonFounder, CEO, & Inventor Vault Data Financial Services Software
We have worked closely with OSP for two years, meeting twice a week to work through development requirements, strategy, design, progress, and support. OSP has become an integral part of our business, and our mutual teams work together as one team. OSP tackles problems that arise with integrity and operate with respect for budgeting.
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Selita JansenWe reached out to OSP to provide an estimate on a technology solution we were interested in developing. From the initial conversation, the team was professional, courteous, and thorough. We were able to make a quick decision to move forward with OSP because we were confident that our requirements were accurately captured and the development deliverables and associated costs were clear. The OSP development team stayed on schedule and within budget throughout the build phase and provided weekly communications to keep our team informed along the way. If we require application development in the future, OSP will be the first call we make.
US is facing a crisis of inadequate care for pregnant women, particularly for those in rural or disadvantaged socioeconomic communities. Shortages of maternal-fetal medicine experts (MFM) have reached critical levels.
Our US-based client wanted to solve this challenge by using technology to provide quality health access to pregnant women. Building a solution that connects MFM experts to pregnant women in the remote local clinic through real-time video streaming was the need of the hour.
Learn More Hear US is facing a crisis of inadequate care for pregnant women, particularly for those in rural or disadvantaged socioeconomic communities. Shortages of maternal-fetal medicine experts (MFM) have reached critical levels.
Our US-based client wanted to solve this challenge by using technology to provide quality health access to pregnant women. Building a solution that connects MFM experts to pregnant women in the remote local clinic through real-time video streaming was the need of the hour.
Learn More Hear US is facing a crisis of inadequate care for pregnant women, particularly for those in rural or disadvantaged socioeconomic communities. Shortages of maternal-fetal medicine experts (MFM) have reached critical levels.
Our US-based client wanted to solve this challenge by using technology to provide quality health access to pregnant women. Building a solution that connects MFM experts to pregnant women in the remote local clinic through real-time video streaming was the need of the hour.
Learn More Hear US is facing a crisis of inadequate care for pregnant women, particularly for those in rural or disadvantaged socioeconomic communities. Shortages of maternal-fetal medicine experts (MFM) have reached critical levels.
Our US-based client wanted to solve this challenge by using technology to provide quality health access to pregnant women. Building a solution that connects MFM experts to pregnant women in the remote local clinic through real-time video streaming was the need of the hour.
Learn More Hear 
Assessment of risk begins with compiling data surrounding patient demographics, clinical encounters, and diagnoses. This provides information on the patients’ medical conditions (if any) and the medical services they might require. This indicates the risk score of each person
Risk adjustment is a method that indicates the health status of a person to a numerical score, called risk score that predicts medical costs to payers. The anticipated risks to a health plan that insures members with high plan usage is adjusted by insuring members with lower predicted health plan usage.
Risk adjustment involves determining which plan member would incur high healthcare costs. This data enables them to adjust their premiums accordingly to remain afloat. Furthermore, doing so enables payer companies to keep providing coverage to all other plan members enrolled.
The three fundamentals of risk adjustment are –
1. Member-Provider Base
This indicates the number of members and the network of providers for insurance payers. The track record of the providers, coupled with the proportion of high-risk members to low-risk members greatly contribute to the risk adjustment.
2. Quality of Medical Charting and Coding
A medical chart is a complete record of a patient’s medical history showing all previous treatments, diagnoses, immunizations, etc. The accuracy of coding captures the clinical visits and generates appropriate claims for payers to reimburse.
3. Data on Clinical Encounter
This is essential not only for medical coding, but also to keep patients’ health records updated for future medical necessities.
Risk management tools enable insurance payers to determine the risk factor for each person being enrolled into health plans. This information is vital to establish the amount charged for premiums in order for the payers to be able to cover the medical costs of their members. Additionally, risk management software tools also help payers balance the number of high-risk members with that of low-risk members. This helps them to ensure that they receive an optimum amount of premiums.
Risk adjustment is a technique that is used to determine a person’s likelihood of using healthcare services, and the cost he or she would incur in doing so. In other words, it enables insurance companies to know which patients are at higher chances of requiring medical attention and at what cost. This data establishes a risk score that highlights patients who would be needing greater coverage.
Subsequently, payers use the risk score to charge the appropriate amount of premiums to cover the riskier enrolees. In Medicaid, it helps to fine-tune the amount in capitated payments the government make for covering members.
Hierarchical Condition Categories (HCC) are sets of medical codes associated with certain diagnoses. They are mainly used by the Centers for Medicare & Medicaid Services to identify people with serious or chronic medical conditions. This is done so as to adjust the payments in coverage for these individuals, as they are more likely to incur higher healthcare expenditure.
Risk adjustment is a way for payers to predict the likelihood of coverage for members of health plans, and the amount of coverage.
Risk management is done by acquiring all the relevant medical information about members of health plans, in addition to data from clinical visits. This helps payers to get a picture of the person’s health condition, after which they allocate a risk score to that person. Higher risk scores indicate that the person is very likely to need medical help in the near future due to poor health, or prevailing medical conditions. In other words, payers would need to spend more on his or her coverage.
On the other hand, lower risk scores indicate that the person is not too likely to need medical services in the near future. In other words, payers won’t likely need to spend more on their coverage.
Risk adjustment is a process that evaluates the likelihood of people requiring medical services, and to what degree. This enables them to charge premiums accordingly to be able to provide coverage to all members of all health plans as per their requirements. People deemed to be riskier usually pay higher premiums as they would likely be needing more coverage.
