In a delegated risk world, the financial outlook for payers and providers is inextricably tied together, with providers taking on most of the risk through reimbursement that is dependent on accurate documentation and reporting. This requires oversight into payer processes that have potential downstream impact on revenue.
Pareto’s Value-Based Reimbursement solution enables providers in risk-bearing contracts to review, analyze, oversee and improve key process that drive risk-based revenue performance.
Oversight into the major factors contributing to revenue allows risk-bearing providers to ensure accurate reimbursement from private payers, CMS and/or state government. This starts with an assessment of data quality and value-based contracts to establish a baseline for subsequent analysis. Then we apply Pareto’s proprietary revenue integrity analytics to identify and prioritize gaps and recommend activities to improve performance.
The potential financial improvement opportunity identified by our Value-Based Reimbursement solution can be more than $8 million for 30K attributed lives.
Our extensive experience working with payers on these activities gives us the insight necessary to facilitate data access and pinpoint issues contributing to lost revenue.
We go beyond surface-level gap identification to uncover the root cause of revenue losses to resolve issues at the source.
Pareto Hub offers unparalleled access to insights through a ready-to-analyze data environment, enabling users to build independent analytics in a self-service manner.
Pareto’s Data Management Platform, the foundation to our solutions, is built around data lake, artificial intelligence, and open source big data technologies to allow us to effectively ingest data in all formats and types at scale, organize them with appropriate data governance mechanisms within our data catalog, and provide efficient configuration capabilities to democratize data access and analytics.
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