Solutions for Health Plans

Pulse8’s vast array of products can address the needs of a number of functional areas, ranging from Finance, Actuary, and Risk Adjustment to Quality and Network Management.  Our modular products all connect through the same Illumin8™ platform and are powered by our Reveal8 engine.  We constructed our products to interchangeably mix-and-match into the ideal solution to fulfill any health plan’s specific objectives.

The most frequent departmental uses of our products include the following:

Risk Adjustment:

Improve your predictive capabilities and confidence levels regarding individual member risk factors with our flagship Reveal8 product, which combines the most advanced risk adjustment analytics with Big Data mining and multiple predictive models to produce the most precise risk adjustment algorithms in the ACA Commercial, Medicare Advantage, and Managed Medicaid markets. Risk Adjustment staff rely on Reveal8 to differentiate gap closure strategies depending on whether conditions are “persisting” or “suspecting” and to avoid pursuing low-yield interventions that will produce little to no impact on risk scores.

Finance and Actuary:

Monitor Pulse8’s algorithmic performance against expected outcomes using Calcul8 and mitigate your audit risks, whether RADV or IVA, using Detector8. Finance Directors, Risk Managers, and CFOs use our Financial Reporting Suite to maintain a watchful eye over their risk adjustment programs and our dashboards to lend a pre-emptive hand when maneuvers need to be made. Whether predicting Medicare Advantage mid-year or final year projections or the ACA Commercial prediction, Pulse8 is the ONLY one to accurately predict Transfer Payment Revenue and our ACA Commercial Modeler is the ultimate tool for calculating the RAF Points needed to achieve budget and the optimal intervention type, level, and timing with which to get there.

Quality Management:

Proactively identify trends in quality measure performance and strategically prioritize quality improvement initiatives using Qualit8 in order to optimally deploy resources towards closing the quality gaps that will produce the greatest economic value. Whether working with cardinal or ordinal measures; relative or absolute determination methods; the ACA Quality Rating System (QRS), CMS Star Ratings, or State-specific Medicaid Models, Pulse8’s advanced analytics can steer QM/QI managers and Star Czars down the most fruitful paths.

Network Management:

Maximize gap closure rates through efficient provider engagement that minimizes provider abrasion and network disruption by leveraging the user-friendly, Self-Service Provider Portal within Collabor8, the Dynamic Intervention Planning within Calcul8, and the EMR integration of our Integr8 technology. Pulse8’s products spare your network providers and office staff the annoyance of repetitious and sometimes unnecessary information requests by prioritizing your targets and coordinating your efforts to close gaps in documentation, coding, and quality all at once.

Claims:

Improve coding accuracy, productivity, and completeness with our Popul8 Coding Technology and ensure timely and accurate Submissions (EDPS/RAPS, EDGE Server, or MEDS II) with our Reconcili8 Encounter Management solution. Our advanced technologies – from Optical Character Recognition and Computer-Aided Coding to Rules Engines and Workflow Management – ensure your claims department is optimally coding and comprehensively submitting the claims and encounter data needed to thrive in today’s risk-adjusted world.

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Solutions for At-Risk Providers

Pulse8’s advanced analytics and risk adjustment expertise provide invaluable support to those responsible for Risk-Adjusted Revenue, Performance-based Contracting, and Quality Management.

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For all general and sales inquiries, please contact us at 410.928.4218 or email us at info@pulse8.com
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