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PRODUCTS

PERFORM+ Regulatory

Accelerate gap closure and improve regulatory performance



PERFORM+ Regulatory - Chase Intelligence

Overview

PERFORM+ Regulatory enables healthcare organizations to manage their regulatory reporting requirements while driving improvement in quality scores for programs like HEDIS, MIPS and ACO. PERFORM+ Regulatory enables comprehensive, insight-driven quality improvement and provider engagement across multiple regulatory programs. It also provides real-time compliance updates and highly configurable automated workflows for improved efficiency and focused measure prioritization.

PERFORM+ Regulatory empowers quality and care management teams to:

      i) Drive HEDIS, Star and state regulatory needs through a unified platform

     ii) Prioritize and accelerate gap closure

     iii) Leverage advanced analytics (including AI/ML) across population and value-based programs

     iv) Improve efficiencies across HEDIS compliance and Medical Record Review

750+

pre-built KPIs / measures

10 states

regional presence

500 M+

visits processed

PERFORM+ Regulatory: Advantage

PERFORM+ Regulatory gives health plans comprehensive insight to drive quality, improve provider engagement and enhance regulatory performance

One-stop

Vertically Integrated Solution Suite

Performance improvement for multiple programs, for HEDIS and beyond (integrated Risk, Population health, Provider performance etc.)

Real Time

AI/ ML Performance Library

Extended library of AI/ML use cases to improve quality planning decisions, segmentation, chase intelligence and data enrichment.

Support for Quality Programs

FHIR Enablement

Available accelerators and expertise for executing FHIR/Interop use cases for Quality based supplemental data collection, ‘gaps in care’ alerts.

Rules Manage

Near Real Time Computation

Ability to carry out daily / weekly processing for accelerated coordination and scale at the speed of business.

MRR

Self Service Informatics

Variety of self-service capabilities viz. Rule authoring, Audit 360 etc. to extend time savings and fast track business decisions.

IP

Optimize Provider Outreach

Reduced provider abrasion and  increase in provider collaboration by identifying the right provider to chase and to close the right gaps.

One-stop

Vertically Integrated Solution Suite

Performance improvement for multiple programs, for HEDIS and beyond (integrated Risk, Population health, Provider performance etc.)

Real Time

AI/ ML Performance Library

Extended library of AI/ML use cases to improve quality planning decisions, segmentation, chase intelligence and data enrichment.

Support for Quality Programs

FHIR Enablement

Available accelerators and expertise for executing FHIR/Interop use cases for Quality based supplemental data collection, ‘gaps in care’ alerts.

Rules Manage

Near Real Time Computation

Ability to carry out daily / weekly processing for accelerated coordination and scale at the speed of business.

MRR

Self Service Informatics

Variety of self-service capabilities viz. Rule authoring, Audit 360 etc. to extend time savings and fast track business decisions.

IP

Optimize Provider Outreach

Reduced provider abrasion and  increase in provider collaboration by identifying the right provider to chase and to close the right gaps.

PERFORM+ Regulatory: Key Components

PERFORM+ Regulatory is highly modular and can be customized to address unique value-based care, ACO, MIPS and HEDIS performance needs.

Measure Engine

BI-Clinical powered Measure Engine with flexibility to configure runs at the speed of business, produces measure output with in-depth auditability and available in various formats to drive active collaboration and quality improvement.

Measure Library

Comprehensive measure library with 650+ measures across HEDIS, CMS MA Stars, CMS Coreset and other state/custom measures

Rules Management Module

Differentiated ability to author / modify HEDIS like measures along with  configuration of NCQA allowable adjustments

Audit 360

Ability to perform population cohort study and single member compliance study across measure-conditions to swiftly  identify focused improvement areas

Run Compare

Allows to compare two measure runs between prior system and PERFORM+ Regulatory or any two ongoing PERFORM+ Regulatory runs for variance study across measure-conditions

Measure Library

Comprehensive measure library with 650+ measures across HEDIS, CMS MA Stars, CMS Coreset and other state/custom measures

Rules Management Module

Differentiated ability to author / modify HEDIS like measures along with  configuration of NCQA allowable adjustments

Audit 360

Ability to perform population cohort study and single member compliance study across measure-conditions to swiftly  identify focused improvement areas

Run Compare

Allows to compare two measure runs between prior system and PERFORM+ Regulatory or any two ongoing PERFORM+ Regulatory runs for variance study across measure-conditions

Medical Record Review

Integrated Medical Record Review with administrative measure engine for Real time compliance update along with configurable automated workflow for improved  efficiency and focused prioritization.

Intelligent Chase Logic

Comprehensive library of chase rules with granular configurability along with inbuilt chase prioritization scoring for provider outreach. 

Flexible Campaign Management

Campaign management module flexibility to create various campaign groupings, customizable provider letter complemented by automated workflow for chase planning and chart upload.

Seamless Abstraction

Split screen view for abstraction with real time compliance check and error codes for improved accuracy. Enables quick go-live for new or additional measures through configurable, data-driven screen builder.

Operational Reports

Out of the box operational report to review efficiency and areas of focus across various workflows along with measure wise compliance impact through Medical Record Review projects

Intelligent Chase Logic

Comprehensive library of chase rules with granular configurability along with inbuilt chase prioritization scoring for provider outreach. 

Flexible Campaign Management

Campaign management module flexibility to create various campaign groupings, customizable provider letter complemented by automated workflow for chase planning and chart upload.

Seamless Abstraction

Split screen view for abstraction with real time compliance check and error codes for improved accuracy. Enables quick go-live for new or additional measures through configurable, data-driven screen builder.

Operational Reports

Out of the box operational report to review efficiency and areas of focus across various workflows along with measure wise compliance impact through Medical Record Review projects

Submission

Unified module for seamless error free submission across NCQA HEDIS®, CMS and other State agencies. 

File Generation

Enables generation of IDSS file for NCQA, PLD file for CMS and other state required  measure and member level files for various state submissions. 

Output Reconciliation

Automated utility to reconcile IDSS and PLD data, automated validation of IDSS and PLD output accuracy along with ready to use reports for representing external audit inquiries.

File Generation

Enables generation of IDSS file for NCQA, PLD file for CMS and other state required  measure and member level files for various state submissions. 

Output Reconciliation

Automated utility to reconcile IDSS and PLD data, automated validation of IDSS and PLD output accuracy along with ready to use reports for representing external audit inquiries.

Analytics & Reporting

Suite of pre-built, configurable analytics tools, dashboards and rich visualizations, including HEDIS, gaps-in-care, Member 360, Measure 360, Provider 360, etc. to improve decision making and accelerate gap-closure

Out-of-the-box Starter Reports

A large set of ready reports (e.g., Quality, HEDIS, HCC, CMS Star, Provider 360, etc.) to make the solution usable from the first day

Predictive Capabilities

Data Science driven capabilities (HEDIS / Stars) to predict measure denominator qualification, compliance rate and identify focused member list for outreach.

Custom Reports

Additional flexibility to add custom reports or modify existing UI. Powerful, intuitive and easy-to-use tools for report creation and customization

Comprehensive Insights

Holistic view of provider, member and measure –rate benchmarking, rate trending,  rate traceability, member drill-downs and provider scorecards

Out-of-the-box Starter Reports

A large set of ready reports (e.g., Quality, HEDIS, HCC, CMS Star, Provider 360, etc.) to make the solution usable from the first day

Predictive Capabilities

Data Science driven capabilities (HEDIS / Stars) to predict measure denominator qualification, compliance rate and identify focused member list for outreach.

Custom Reports

Additional flexibility to add custom reports or modify existing UI. Powerful, intuitive and easy-to-use tools for report creation and customization

Comprehensive Insights

Holistic view of provider, member and measure –rate benchmarking, rate trending,  rate traceability, member drill-downs and provider scorecards

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* As per regulation § 170.523(k)(1)(iii) of the ONC 2015 Edition Final Rule, the Cost and Limitations and Product Information Statement for BI-Clinical can be found here:  BI-Clinical 18.4, BI-Clinical 18.11, BI-Clinical 2020.1904 , BI-Clinical_BIC2021

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)