BIG DATA + ADVANCED ANALYTICS = IMPROVED RESULTS

Pulse8 is the ONLY analytics and technology company empowering its customers to achieve the highest financial impact and quality outcomes in the Commercial Health Exchanges, Medicare Advantage and Medicaid markets.

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ABOUT US

“The Most Powerful Analytics in the Marketplace”

Pulse8 is the ONLY analytics company that can reduce your administrative spend, improve your revenue objectives and deliver innovative solutions that engage your network physicians and facilities.

Our approach to risk adjustment and quality focuses on reducing waste and brings forth innovative technologies designed to eliminate interventions that deliver little or no financial benefit.

MEET OUR TEAM

We are a compassionate team of thought leaders and industry experts focused on bringing our customers the best value through our advanced analytical solutions. We strive to enhance our customers’ products and services by providing innovative and transformative knowledge that will increase revenues, contain costs, and help people live healthier and longer lives. Our values, technology, experiences, and skills create a unique approach to solving many of today’s complex issues in healthcare.

John Criswell, MBA – Chief Executive Officer

John is one of the leading health care industry experts in risk adjustment, quality, and outcomes.  He has a deep appreciation for and understands the intricacies of the health care delivery system. He has designed and deployed predictive models using complex algorithms, big data, and consumer data for many of the top health plans.  As CEO, John is an energetic innovator driven to reduce waste, improve financial performance, and help Americans live independent and healthy lives.

Scott Filiault- Chief Revenue Officer

Scott is a leader in health care management programs with over two-decades of experience delivering market leading predictive models, advanced stratification, and financial performance.  He has a passion for improving health plan performance and profitability through effective, state-of-the-art care management programs, advanced analytics, and data-driven strategies.  He has developed marketing strategies for predictive modeling, disease management, and assessment programs.  Scott is focused on expanding the mission, developing new markets, and building partnerships.

Selina Dennis – VP, Marketing

Selina is a frontrunner in promotion, social media, and marketing strategies. She is responsible for promotions; special event marketing; partnership relationships; advertising; and online marketing.  She creates, manages and leads the implementation of integrated marketing plans and tactics to grow Pulse8’s market presence.  Selina has a proven track record of success as a fast-growth marketing and business development leader in the healthcare industry.  Her experience spans insurance, long-term care, behavioral health, urgent medical care and hospice/palliative care markets.  She has been instrumental in creating successful programs and campaigns that build relationships between healthcare insurers, retail health, and patients, as well as positioning company products and services favorably in the healthcare market.

Paul Schiele – VP, Information Technology

Paul Schiele is an expert in Big Data, analytics, informatics, and infrastructure deploying secure systems designed for large health systems. He is a strategic innovator who has built and deployed technology programs for the world’s leading health organizations. He is responsible for systems and technology with a keen attentiveness towards data security and governance.  Paul is driving new product development leveraging advanced technologies that deliver significant value for our customers.

Shelley Binkley- VP, Customer Engagement

Shelley is a decisive leader with proven success in strategic planning, cost reduction, problem solving and idea generation. She has a proven track record of driving results, exceeding objectives and fostering strong relationships.  Shelley is the customer advocate that facilitates a deep understanding of collaboration.

Chris Simmons, FNP – VP, Provider Engagement

Chris leads the clinical team responsible for design, development, and implementation of provider engagement products.  He develops long- and short-term provider engagement strategies and goals, oversees implementation including evaluation of outcomes.  He monitors quality management activities and acts as the liaison with IT regarding program integrity. Chris is considered an expert in Risk Adjustment and has worked with multiple large group practices to identify internal barriers of adoption and developed strategies to drive improvement in documentation gaps, coding, and improving HEDIS quality scores.

PRODUCTS

Illumin8™ is the ONLY platform you’ll need for all of your risk adjustment and quality programs.

Components of the platform are:

RISK ADJUSTMENT ANALYTICS

Commercial Exchange. Medicare Advantage. Medicaid.

Pulse8 provides the most precise and targeted risk adjustment analytics removing waste from your intervention programs.  We have the most sophisticated algorithms in the industry combined with our dynamic intervention planning.  We analyze populations more objectively and independently with speed and accuracy.

QUALITY ANALYTICS

Star & Commercial Rating Systems

Pulse8 analytics facilitates successful quality measures for any given MA-PD, PDP, or Commercial  contract by delivering true control panel functionality to end users’ fingertips. Pulse8’s Business Intelligence enables health plan professionals to gauge Key Performance Indicators towards smart, cost effective quality program success.

PREDICTIVE MODELING & DYNAMIC INTERVENTION PLANNING

Better Informatics + Analytics= Better Targeting

Analytics inform us where to focus limited resources.  Predictive modeling identifies specific factors that are associated with natural gap closure.  Event Sequencing tools simplify temporal patterns that impact natural gap closure.  Low-confidence cases are identified avoiding costly interventions.

BUSINESS INTELLIGENCE

Powerful. Extensive. Flexible

Pulse8 provides actionable data in real time tracking performance against expectations and key milestones.  Our Visualization and Reporting portal is securely connected to our datasets to provide you with the latest information to create and execute any number of business intelligence reports.

PROVIDER ENGAGEMENT

Illumin8 offers self-service education, benchmarking, reporting, alert, documentation, and care gaps for Providers

Engage your providers with actionable information within a provider’s point of care workflow. The application offers efficient physician collaboration to advance quality and risk score accuracy initiatives.  The Member-specific detail offers providers insight at the point of care.

MEMBER ENGAGEMENT

Telephonic HRAs

Our proprietary algorithms identify members who may benefit from a telephonic HRA.  The telephonic survey assists in the identification of assessment needs that may include, but are not limited to, chronic physical conditions, incapacity in key activities of daily living, dementia, mental health or substance abuse. The intervention is targeted to identify these unassessed needs and assist the member in obtaining an individual care plan from their PCP.

Member Benefit Card

Pulse8’s Member Benefit Card allows for real time analytics delivered at the point of care to address quality and risk adjustment gaps. The embedded technology within the card provide highly secure features to validate member identity as well as deliver impactful and actionable information pertinent to the patient visit. It is more important than ever for health plans to address critical issues with patients and doctors in order to manage cost and quality of healthcare delivery. Effective care management requires information to be current at the point of care and delivered in a secure manner as part of the encounter.  Pulse8’s Member Benefit Card is the best solution to effectively identify and address risk adjustment and quality at the point of the care.

SUBMISSIONS & DATA VALIDATION

Edge Server Submissions

Pulse8 Encounter Management Product produces accurate and timely edge-server submissions of member and claim data ensuring HHS compliance for the Risk Adjustment and Reinsurance premium stabilization programs.

RAPS/EDPS

Pulse8 EDPS and RAPS Product ensure complete and accurate data submissions through diagnosis gaps, error reporting, missing claims prior to and during filtering, and statistical analysis of submissions.

CODING

Pathway to Self-Sustainability

Developed specifically for health plans who are seeking to create a pathway to self-sustainability while providing a high degree of clinical accuracy and an audit defensible program.  

Built by coders for coders, this system benefits from a strong suite of operation-centered capabilities that include coder performance metrics, automatic chart queuing and allocation, and quality alerts and optimization.  Our platform allows coders to be productive and optimizes efficiency through intuitive navigation and customizable user group privileges.  Easy-flow code entry screen give coders a productivity edge. Multi-level quality control and auditing capabilities ensure high quality output, even from new coders.  Quality feedback and scores are streamlined to improve productivity of auditors and supervisors.

TECHNOLOGY

ADVANCED BIG DATA APPROACH

Traditional Data + New Data = Better View of Members
Effective utilization of all data sources improves confidence levels offering new visibility into our members improving financial performance and containing cost.

Modern Informatics and Analytics

Our products were created using the following tools, and many of our ad hoc data services take advantage of these methodologies.

  • Predictive models. Regression models, neural networks, tree-based models, and Bayesian modeling to predict a variety of healthcare outcomes.
  • Cluster analysis. Tree-based, partitioning, and model based tools to put unstructured data into actionable groups.
  • Visualization tools. Once data are graphed and plotted in creative ways using advanced software, the human eye can detect a variety of patterns that might lead to opportunities.

Applying domain knowledge and evidence-based medicine is critical; our results are based on modern clinical and health services research to ensure that the results truly will lead to cost reduction and health improvement.

Contact Pulse8

INDUSTRY INSIGHTS

A SUMMARY AND ANALYSIS OF FEBRUARY 2015 CMS MEDICARE ADVANTAGE 2016 ADVANCE NOTICE

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NEWS & EVENTS

Illumin8 is designed to reduce administrative spend, improve revenue objectives, and deliver innovation at the point of care for Commercial, Medicare, and Medicaid Plans and programs.

As the leader in big data, risk adjustment and healthcare analytics, Pulse8 offers its expertise in first of three-part webinar series focused on ACA challenges

In partnership with RISE Association (Resource Initiative and Society for Education) Pulse8 brings its independent and unbiased expertise to risk adjustment and revenue management for healthcare audiences in a webinar titled “Innovate or Disintegrate! Take Action or Watch Your Margins Erode”.

“Predictive Modeling Analytics and Strategies for Personalized Care Management” for Medicare Advantage Risk Adjusted Population

Mickey Dodge, Brian Tajlili and John Criswell as featured speakers in RISE Conference “Product Design, Pricing & Risk Adjustment on the Health Insurance Exchanges" in Las Vegas on February 17-18, 2014 will bring expertise to offer insight and strategies for Commercial data, quality, and pricing processes.

Scott Filiault Joins Pulse8 as Chief Revenue Officer

Maryland Primary Care Physicians, one of Maryland’s premier providers, is implementing Pulse8’s new risk adjustment technology program to quickly assess and assist patients in finding the most appropriate care.

As the leader in big data, risk adjustment and healthcare analytics, Pulse8 offers its expertise in first of three-part webinar series focused on ACA challenges

An innovative, integrated product enables revenue and utilization managers to clearly understand which engagement techniques have the most positive impact at any given moment across their entire risk adjustment and utilization management programs.

Pulse8 CEO John Criswell is Featured Speaker at RISE Conference "2nd Annual Health Insurance Exchange Summit" in Las Vegas, NV on November 18, 2013

John Criswell, Founder and CEO of Pulse8 - a cutting-edge healthcare analytics provider focused on risk adjustment solutions for the Health Insurance Exchanges - will present “Demystifying the Black Box of Analytics” at the RISE and HEA 2013 Risk Adjustment and Revenue Management Conference taking place June 20-21, 2013 in Westlake, California.

John Criswell, Founder and CEO of Pulse8—a state-of-the-art analytics company focused on helping people live independent and healthy lives—announces Pulse8’s Health Exchange Suite.

DI & LTC Insurers’ Forum September 12-14, sponsored by LIMRA/LOMA/SOA.

550b2b48836b5b2f6c2cdcb9_Pulse8-Ad06.jpg Download PDF