Risk adjustment & quality

Risk adjustment & quality

Named #1 in Risk adjustment and Best in KLAS 2022

Risk adjustment & quality

Named #1 in Risk adjustment and Best in KLAS 2022

EXL Risk Adjustment

EXL Health looks and goes deeper to find a better way

EXL Health’s modular, end-to-end risk adjustment and quality management solutions deliver optimized performance on risk-adjusted populations, including improvements across clinical documentation, quality outcomes and accurate reimbursement.

By combining deep domain expertise, cutting-edge technology, and advanced analytics, we help you achieve accurate risk and quality scores. Our AAPC-certified risk adjustment and quality services cover the full spectrum of support and are designed to meet our clients where they are on their value-based transformation journey. We partner closely with our clients to identify and engage the right patients at the right time to ensure they receive high-quality, coordinated care.

Who we serve

EXL Health partners with and delivers our clinical services to both health plan payer and provider organizations. We support driving value-based outcomes and transformation in order to support improvements to member health outcomes, medical cost containment and quality compliance.

Industry analysts recognize our excellence

EXL Health’s Risk Adjustment and Quality Management organization embodies human ingenuity to propel the success of our clients by solving their most complex problems. We take a relentless approach to getting results and deliver outcomes through a highly flexible, collaborative and responsive approach, enabling us to form strong, long-lasting partnerships with our clients who look to EXL Health as a strategic partner today, tomorrow and for years to come.

It’s one of the reasons why EXL Health was named Best in KLAS 2022 for Risk Adjustment, with 100% of our customers stating that they would purchase EXLCLARITY™ again

Risk Adjustment

 

Featured insights
Many health plans still struggle with incomplete or inaccurate risk adjustment submissions despite high-quality first-pass coding. As the industry landscape continues evolving around compliance audits, health plans face increasing pressure to find cost effective solutions to reduce their risk exposure.
Analytics is typically used to make sense of data. Traditionally, it results in an understanding of the past. Predictive analytics is turning this equation on its head by moving beyond retrospective analysis and providing insights on what is likely to happen in the future.
At the start of the COVID-19 pandemic, the healthcare community faced many uncertainties. ERs were flooded with COVID patients and providers saw utilization rates for scheduled patients drop dramatically, causing a gap in patient care and decreased revenue.
It happens every spring: HEDIS data abstraction and submission for the previous years’ measures. During peak season, payers and providers alike rush to collect and complete requests for medical records, claims, data verification, and audits. While HEDIS is an effective tool to ensure care is meeting quality standards, it can put a strain on both overworked staff and relationships with providers and members.