Insurance & Payers

Documentation That Drives Value-Based Success

Maximize risk adjustment, improve quality metrics, and excel in value-based care with AI documentation designed for payer partnerships.

Payer Partnership Challenges

Success in value-based care requires precise documentation and comprehensive quality tracking

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Documentation Quality

Ensuring provider documentation supports accurate risk adjustment and quality metrics

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Coding Accuracy

Capturing all relevant diagnoses and procedures for proper reimbursement

Quality Reporting

Meeting HEDIS, Stars, and other quality measure requirements

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Risk Adjustment

Maximizing HCC capture and supporting accurate RAF scores

Measurable Impact on Payer Performance

Enhanced Risk Adjustment

Capture all relevant HCCs with real-time prompts and documentation assistance for accurate RAF scores.

Quality Measure Automation

Automatically track and document HEDIS, Stars, and MIPS measures during routine patient encounters.

Gap Closure Integration

Import care gap lists and seamlessly close gaps during visits with appropriate documentation.

Value-Based Reporting

Generate comprehensive reports for payer partnerships and value-based care contract performance.

25%
Improvement in HCC capture
More complete diagnosis documentation
40%
Better quality measure performance
Automated HEDIS and Stars metric tracking
15%
Increase in coding accuracy
More precise documentation for claims
$500K
Additional revenue per 1,000 members
Through improved risk adjustment

Payer-Focused Features

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HCC Documentation Assistant

Real-time prompts to capture additional diagnoses that support risk adjustment

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Quality Measure Tracking

Automatic identification and documentation of HEDIS, Stars, and CMS measures

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Gap Closure Support

Identify and document care gaps during routine visits

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Coding Optimization

Ensure documentation specificity supports accurate ICD-10 coding

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Risk Stratification

Support population health initiatives with comprehensive documentation

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Value-Based Reporting

Automated data collection for value-based care contracts

Comprehensive Quality Measure Support

HEDIS Measures

  • Diabetes Care (HbA1c control, eye exams, nephropathy)
  • Cardiovascular Care (BP control, statin therapy)
  • Preventive Care (mammograms, colonoscopies, immunizations)
  • Behavioral Health (depression screening, follow-up)

Medicare Stars

  • Health Outcomes Assessment
  • Patient Experience (CAHPS)
  • Intermediate Outcome Measures
  • Patient Safety and Clinical Care

CMS Innovation

  • Merit-based Incentive Payment System (MIPS)
  • Alternative Payment Models (APMs)
  • Shared Savings Program metrics
  • Quality Payment Program requirements

Optimized Payer Workflows

Risk Adjustment Optimization

Maximize HCC capture during routine visits

  1. 1 Review patient's historical diagnoses
  2. 2 Prompt for condition updates during visit
  3. 3 Ensure specificity in documentation
  4. 4 Verify coding compliance
  5. 5 Generate risk adjustment report

Quality Gap Closure

Address care gaps identified by payers

  1. 1 Import gap list from payer systems
  2. 2 Present relevant gaps during visits
  3. 3 Document completed services
  4. 4 Update quality metric status
  5. 5 Report closure to payers

Value-Based Care Support

Support providers in VBC contracts

  1. 1 Track contract-specific metrics
  2. 2 Provide real-time performance feedback
  3. 3 Document care coordination activities
  4. 4 Monitor outcome measures
  5. 5 Generate contract reporting

Supporting All Payer Partnership Models

Medicare Advantage Plans

Medicaid Managed Care Organizations

Commercial Health Plans

Accountable Care Organizations

Medical Groups in Risk Contracts

Independent Practice Associations

Clinically Integrated Networks

Direct Primary Care Practices

OrbDoc integrates with major payer systems and supports custom API connections for real-time data exchange.

Calculate Your Value-Based Care ROI

See the potential revenue impact from improved risk adjustment, quality measures, and gap closure with our specialized ROI calculator for payer partnerships.

Payer Integration Support

Data Integration

Connect with payer systems for real-time gap lists, quality measure tracking, and performance reporting.

Contract Configuration

Customize documentation workflows based on specific payer contract requirements and quality measures.

Training & Adoption

Comprehensive provider training on value-based care documentation and HCC capture best practices.

Performance Monitoring

Ongoing monitoring and optimization of documentation quality and payer performance metrics.

Ready to Excel in Value-Based Care?

Join practices already maximizing their payer partnerships with OrbDoc

Specialized support for value-based care contracts and payer partnerships