Pulse8's CEO to Address Risk Adjustment Hurdles that are Unique to Plans on the Exchange

Share Article

John Criswell, Chief Executive Officer at Pulse8, will discuss why Risk Adjustment analytics are not reciprocal between HIX and Medicare Advantage at the RISE Revenue Management for HIX Plans on December 1st at 9:45am

John Criswell will be presenting as a Gold Sponsor at the Revenue Management for HIX Plans conference organized by Healthcare Education Associates and RISE, in San Diego, CA from December 1-2nd, 2015.

Mr. Criswell will address why Risk Adjustment analytic solutions for the Health Insurance Exchanges (HIX) should not be treated with the same regard as Medicare Advantage. In his discussion, Mr. Criswell will cover topics such as:

  • Why MA intervention strategies fail so miserably in HIX
  • Why HIX needs quantification/monetization of opportunities and closed gaps in terms of contribution to net transfer payments
  • Understanding impact of the high out-of-pockets in HIX plans on finding and closing gaps (OOPs as barrier to access)
  • Properly scoring: CSR categories, reinsurance calculations

Pulse8 Risk Adjustment and Big Data experts will be onsite to offer health plan and provider attendees:

  • Interactive demonstrations of its revolutionary Risk Adjustment analytics;
  • Insight into how big data and advanced analytics can be used to find more opportunities, intervene more precisely, and obtain superior financial results; and
  • Real-time visibility into individual member and provider activities that allow health plans and providers to drill down and move quickly in order to deploy the most cost-effective and appropriate interventions.

About Pulse8
Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of Risk Adjustment and Quality Management programs. We enable health plans and at-risk providers to achieve the greatest financial impact in the Health Insurance Exchange (HIX), Medicare Advantage, and Medicaid markets. By combining advanced analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment. Pulse8’s flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality.

About Healthcare Education Associates
Healthcare Education Associates is a division of Financial Research Associates, LLC. HEA is a resource for the healthcare and pharmaceutical communities to improve their businesses by providing access to timely and focused business information and networking opportunities in topical areas.

About RISE
RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

John Criswell, Chief Executive Officer
Pulse8 Inc.
+1 (443) 223-2271
Email >

Scott Filiault, Chief Revenue Officer
Pulse8 Inc.
(732) 570-9095
Email >
@Pulse8News
Follow >
Visit website