Clinical Connectivity
Improve access to Clinical Data for better healthcare outcomes
Clinical connectivity means that health plans are able to easily and effectively access clinical information, enabling risk adjustment, care management, and quality reporting, to achieve better patient experience, reduce operational cost and minimize workflow burdens.
Our solution transforms clinical and claims data into the FHIR format, facilitating the use of both internal and external data, while achieving CMS compliance. Our platform and products enable population health analytics, and promote interoperability between payers and providers.
Risk Adjustment
1upHealth helps payers to ascertain members’ with a higher risk score, or assess if there’s a need to modify payments due to what future members’ care costs are based on conditions coded in the EHR.
Our FHIR-based platform enables health plans to seamlessly connect to providers’ repositories to obtain members’ clinical data to accurately assess their health risks.
Enhance risk assessment
Identify current and future member’s risk by leveraging shared clinical and claims data. Our platform enables data-analytics like features to improve medical and business workflows.
Identify Dropped or Suspect Codes
Analyze historical claims and clinical data to identify patient’s history. Analyze risk adjustment to identify diagnosis codes or HCC codes supporting prospective and retrospective reviews.
Manage Care Quality
We understand that improving the experience of care for patients, whilst reducing per capita costs of healthcare, requires an effective Care Management strategy. 1upHealth equips care managers with quality data and insights that contribute to reducing health risks and per capita costs associated with patients’ care.
EMPOWER
MEMBERS
Give your high risk and complex members the attention they deserve through data-driven risk stratification and prioritization. Help them with making or keeping appointments by coordinating with their provider, or help them maintain their routine checkups to manage different conditions.
1UPHEALTH
SMART HEALTH APP
Our FHIR-based SMART standard creates an application tailored to the needs of providers. Working with top EHRs including Epic, our app enables a complete patient record, available with just a few clicks.
GET ELECTRONIC HEALTH DATA FROM EXTERNAL SYSTEMS
1upHealth is connected to thousands of hospitals and health centers across the US. Patients within any of those systems can authorize access to their external health data and enable your organization to incorporate that within the source system’s EHR data.
Improve Care Quality
1upHealth helps health plans to maintain top HEDIS Star ratings through quality measure reporting.
Our platform aggregates clinical data from different sources (ie. providers) to measure various metrics of your members’ health. By combining external clinical and internal claims data in one place, health plans will be able to have a complete, aggregated and reliable view of a member’s health. By doing so, health plans will be able to submit proper quality measure reporting evidence, enabling better reimbursement and the opportunity to maintain or improve the current rating status.
Complete view of a patient’s health
See which members have gotten a flu shot, or had a breast cancer screening so that you identify the best course of action for each individual within your plan.
Quality Management solution.
Meet quality, cost, revenue, satisfaction, and compliance objectives to help your health plan succeed.
Why FHIR
1upHealth’s platform ingests disparate data sources and formats, cleaning them up, before converting them into FHIR®. FHIR is an HL7 standard that makes it easier to access, integrate, and share data across the healthcare industry.
For Health plans, 1upHealth’s platform can take different endpoints and normalize data via common standards. For example, we can take Epics FHIR endpoints & Athenahealth’s (sometimes non-FHIR) endpoints, so that your health plan can always interact with us in the same way.
Why the 1upHealth platform can deliver this
We connect to top EHRs, such as Epic and Athenahealth, pull that data from the EHR via FHIR queries and combine it with payer data in our FHIR Platform. For example, through Epic’s app store, App Orchard, our app 1upHealth Connector, connects to Epic, obtains clinical data, and sends it to the health plan.
Through a joint contract, a provider can share the clinical data of your members, enabling you to combine clinical and claims data (and sometimes pharmacy data). This will allow you to run analytics on this data, generate insights, and obtain a holistic view of a member’s (patient’s) record. This way, you can internally make use of these insights, or share them back with the provider.