A Complete Ecosystem to Manage Risk, Quality, and Cost of Care
Equabit provides a comprehensive and fully supported Software as a Service (SAAS) solution that simplifies the intricacies of managing diverse data, delivering a state-of-the-art analytics platform, and providing guided workflows that utilize intelligent automation to engage members. With the aim of increasing the likelihood of each individual receiving proper preventive, chronic, and acute care when required, Equabit harnesses the power of Machine Learning and Artificial Intelligence to create a complete ecosystem of care management capabilities, incorporating statistical mining, predictive modeling, and actionable insights. Health systems, payers, and ACOs can integrate these capabilities and workflows into their existing operations to improve decision-making and operational efficiency.
Our areas of specialization center on population health management, streamlining opportunities within supplemental revenue programs, accurately projecting DHCS Stoplight Reports, and offering essential strategies to achieve “Green Light” status across all service categories. Our aim is to position your organization for long-term success by providing a distinct competitive advantage in the dynamic Medicare and Medicaid markets.
We provide services that are designed with the latest technology to ensure top-notch security, scalability, and flexibility, which are essential for adapting to the constantly changing business environment. Our solutions can be tailored and combined to fit your specific business and technology needs. In addition, our framework is designed to be easy to integrate with your existing internal systems or third-party solutions, providing you with a hassle-free experience.
Our analytics module is an intuitive and powerful tool that helps care management teams efficiently coordinate care for high-risk patients while optimizing resources. By providing prescriptive insights into both clinical and non-clinical risk factors, care managers can engage with patients in a more meaningful way. Our customizable dashboards feature dynamic graphs and charts that allow users to drill down into each patient's medical history, doctor's visits, procedures, chronic conditions, lab results, and disease-specific predictive risk scores, leveraging all available socioeconomic data points and utilization patterns. Our platform facilitates cost reduction, enhances quality measures, and optimizes specialized care.
Risk and Quality
Inaccurate risk scores coupled with mediocre suspect logic cost payers millions of dollars in the failed opportunity which are then further exacerbated by improper prioritization of care that lead to undesirable outcomes.
Our AI-driven, state-of-the-art health suspect algorithm aims to maximize risk-adjustment revenue, improve quality scores, reduce costs, empower more proactive care interventions, and improve outcomes for your members. Our analytics further highlights low-performing providers with high-risk members to steer them into in-home visits where they receive both comprehensive and timely care.
You can differentiate your business in the market with high-quality ratings, which leads to higher reimbursement and higher membership enrollment. Facilitate gap closure in Star Ratings, QRS, and other quality measures using machine learning analytics to identify and prioritize the quality gaps most worthy of attention and to recommend the ideal intervention method and the timeline for closing each. Our reporting engine also generates patient cohorts such as risk stratification, ER Frequent flyers, etc. to ensure Improved care reach and the data is available when needed, thus optimizing results.
Engagement and workflowsEffective and timely engagement is the new normal. Having timely insights and accurate data points only pinpoints the risks and opportunities but having the ability to take timely action on this data, brings the true value to a payer business. Equabit offers a highly effective and custom member engagement ecosystem, that is seamlessly integrated into the analytics platform and our AI engine. A guided and customizable set of workflows helps the care management team to take timely actions in managing the immediate needs of high and rising risk patients. Equabit’s predictive and prescriptive models enable the intersection of right members at the right time with the right message creating a conducive and effective intervention ecosystem.
Advanced Reporting EngineRegulatory requirements and reporting standards will increase and evolve, especially since the pay-for-performance approach gets broader adoption overtime and entails higher transparency in quality and pricing information. Accordingly, CMS will look into updating certain benchmarks and incentives, some of them will be reworked eventually. These changes are only adding to the reporting and analyzing burden for healthcare organizations from ACOs to private practices. Equabit’s advanced reporting engine is a truly flexible and performant platform that offers real-time reporting, Intelligent Dashboards, and Data Visualization. This enables calculation and submission tracking simple, saving you time, money, and helping improve your overall performance.
Natural Language ProcessingTypically 80% of a patient’s information is locked inside unstructured data, but Equabit’s powerful NLP engine uses machine learning to extract accurate information, such as condition, procedures, medication, dosage, strength, and frequency from your existing sources. Machine learning-based NLP uses models that can reliably understand the medical information in unstructured text, identify meaningful relationships, and improve the value of this data over-time. By leveraging our automated NLP engine, health plans can enhance the accuracy of HCC coding to drive the member population’s RAF scores, leading to increased benchmarks. In addition, our NLP technology helps you improve HEDIS measures and STAR ratings. Our AI-driven NLP engine alleviates the burden of manual coding so your coding teams focus on simply validating samples and produce accurate outcomes much faster.
Fraud, Waste and Abuse
The National Health Care Anti-Fraud Association estimates that we lose tens of billions of dollars to fraud each year, and many estimates climb much higher. The Coalition Against Insurance Fraud asserts that we lost $487 billion to fraud and human error in a single year, comprising about one-fifth of the total cost of healthcare. The scale of this problem is large enough to make it a priority issue for any health payer. Traditional systems and methods of detecting health care fraud and abuse are time-consuming and inefficient.
Equabit offers a sophisticated solution that uses distinct fraud detection machine learning models which can help payers and ACO’s to extract useful information from thousands of claims and identify the ones that need further investigation. Our FWA models help in the early detection of anomalies and variances from standardized clinical routines. The prescriptive model identifies necessary corrections to remediate the root causes and further tune the FWA model to reduce ‘false positives’. In addition to reducing costs, our FWA model helps minimize additional strain on processes and downstream administrative costs.
Data WarehouseData is your biggest asset but the legacy systems and data silos in a typical environment fail to provide a timely, simple and informative view. Equabit’s proprietary data platform seamlessly integrates with your existing datasets and provides a quick and simple mechanism to streamline your data pipeline so you can harness the true potential of your data. Embedded routines and ML algorithms constantly monitor the quality of data ingested and stored to ensure high-quality data is fed to dashboards, analytics, and applications.
AI-Powered AnalyticsOur analytics module is an intuitive, easy-to-use, and powerful tool that provides care management teams with a deep view of each prioritized member so they can coordinate care for high-risk patients while optimizing their time and resources. Having a complete view of both clinical and non-clinical risk plus prescriptive insights gives care managers an opportunity to engage with patients in a more meaningful and personalized way. We offer customizable and intuitive dashboards, dynamic graphs and charts that allow users to drill down into each patient’s medical history, doctor’s visits, procedures, chronic conditions, lab results, disease-specific predictive risk scores, all available socioeconomic data points, and member utilization patterns. In addition to cost reduction and cost avoidance, our platform also empowers the care team with tools to boost quality measures and optimize specialized care.
Risk and Quality
Our advanced AI health suspect algorithm helps payers optimize their risk scores, enhance quality scores, and lower costs while improving patient outcomes. By identifying low-performing providers with high-risk patients, our analytics can direct care interventions towards in-home visits to ensure timely and comprehensive care. This solution can help mitigate the costly effects of inaccurate risk scoring and subpar decision-making, ultimately leading to more desirable results for all parties involved.
Elevate your business in the market with superior ratings to attract higher reimbursement and more members. Utilize our machine learning analytics to pinpoint and prioritize the most crucial quality gaps and recommend ideal interventions with timelines for closure in Star Ratings, QRS, and other quality measures. Additionally, our reporting engine generates patient cohorts, such as risk stratification and ER Frequent flyers, ensuring better care accessibility and data availability for optimized outcomes.
Engagement and workflows
Advanced Reporting Engine
As the healthcare industry moves towards a pay-for-performance model, regulatory requirements and reporting standards will continue to evolve and become more stringent, with an increased focus on transparency and quality metrics. The burden of reporting and analyzing data falls on healthcare organizations, from ACOs to private practices, and CMS will continue to update benchmarks and incentives.
Equabit's reporting engine provides a comprehensive solution that is both flexible and high-performing. With real-time reporting, intelligent dashboards, and data visualization, Equabit simplifies calculation and submission tracking, saving valuable time and resources while improving overall performance.
Natural Language Processing
Fraud, Waste and Abuse
Healthcare fraud and abuse are critical issues, costing the industry tens of billions of dollars annually. The Coalition Against Insurance Fraud reported a loss of $487 billion in one year, making up a fifth of the total cost of healthcare. Traditional methods of detecting fraud are time-consuming and ineffective.
Equabit's solution utilizes advanced machine learning models to detect potential fraud and abuse in thousands of claims. Our models help payers and ACOs quickly identify anomalies and deviations from standardized clinical procedures. Our prescriptive model suggests corrective actions to remediate the root causes and further refine the FWA model to minimize false positives. By reducing costs and streamlining administrative processes, our FWA model can alleviate the burden of healthcare fraud and abuse.
Your data is one of your most valuable assets, but in a typical environment, legacy systems and data silos often hinder the ability to obtain a timely, easy-to-understand, and informative view. Equabit’s exclusive data platform integrates seamlessly with your current datasets, delivering a fast and straightforward mechanism to streamline your data pipeline and unleash the full potential of your data. Our platform includes embedded routines and machine learning algorithms to continuously monitor data quality, ensuring high-quality data is fed into dashboards, analytics, and applications.
Healthcare generates vast amounts of valuable data, yet the industry has struggled to fully utilize it to drive meaningful insights and informed decisions. Without the ability to harness this wealth of information, organizations risk falling behind and missing out on critical opportunities for growth and improvement.
Equabit’s advanced Big Data platform empowers healthcare organizations to unlock the full potential of their data, allowing them to drive innovation, increase efficiency, and improve patient outcomes. With powerful analytics capabilities and advanced machine learning algorithms, Equabit’s platform provides the tools and insights needed to make informed decisions and drive success in an increasingly competitive healthcare landscape.
To achieve accurate predictions in healthcare, relying on a predictive analytical model alone isn't enough. Without current, comprehensive, and precise data, the insights generated may not be fully reliable. Standard BI tools often have limited access to data, which can restrict the identification of potential risks.
At Equabit, our AI-driven predictive analytics engine goes beyond the traditional approach by utilizing the full capabilities of Big Data frameworks. By leveraging additional clinical and demographic data, our engine provides a more detailed and accurate understanding of a patient's health status and associated risks.
In a dated enterprise healthcare environment, patient information is often fragmented, with inconsistencies and data quality issues caused by human or system errors adding further complexity to datasets. In a value-based healthcare environment, maintaining correctness and consistency across disparate systems is crucial to ensure accurate reporting, promote superior care quality, and improve overall revenue.
Equabit’s Complete Member Profile (CMP) utilizes the power of Big Data to seamlessly integrate information from multiple EMR sources and other available data sources, whether internal or third-party, to create a near real-time 360° concentric view of a member. This holistic view enables healthcare organizations to better understand their patients, leading to more informed decision-making and ultimately improving patient outcomes.
Our powerful Big Data framework can seamlessly integrate with any PGHD (patient-generated health data) or external data source, amplifying the efficacy of your continuous care delivery programs, especially for chronic disease management.
Real-time insights, such as abnormal blood glucose levels for diabetes patients, significant SpO2 level changes for COPD patients, and overall trends in patients' nutrition, hydration, temperature, weight, and blood pressure can be crucial for care teams to take immediate action or make timely adjustments to patients' care plans. These insights can lead to more personalized care, improving patient outcomes and satisfaction.
Preventing Medication Errors
In the healthcare industry, medication errors pose a significant risk to patient safety, and even a minor oversight can result in adverse consequences. Even the simplest mistakes, such as selecting the wrong medication from a drop-down menu, can have severe repercussions. Equabit's advanced Big Data platform, augmented by our innovative machine learning engine, meticulously scrutinizes the patient's medical records and all prescribed medications. The system identifies any potential outliers and promptly flags them for the care team's attention, significantly reducing the risk of medication errors and ultimately ensuring patient safety.
As the healthcare industry shifts towards a pay-for-performance model and regulatory requirements become more stringent, organizations across the spectrum are grappling with the added burden of reporting and analyzing data. Keeping up with the ever-evolving benchmarks and incentives mandated by CMS can be both time-consuming and costly.
Equabit's cutting-edge reporting engine provides a highly flexible and efficient solution to this challenge, offering real-time reporting, intelligent dashboards, and advanced data visualization capabilities. Our platform streamlines the process of tracking calculation and submission, freeing up valuable time and resources and enhancing overall performance.
Unplanned hospital readmissions are a massive drain on healthcare resources, costing organizations billions of dollars annually. To combat this issue, healthcare organizations are turning to their wealth of data in order to reduce costly readmission rates. With the increasing adoption of value-based care initiatives like CMS’s Hospital Readmissions Reduction Program (HRRP), the need for effective data-driven strategies has never been greater.
Equabit’s advanced Big Data platform integrates electronic medical records (EMR) with a wide range of socioeconomic data sources to create a cutting-edge data warehouse. Our proprietary risk stratification algorithms generate individual risk profiles, which can help to proactively predict a patient’s likelihood of readmission. With the help of our guided workflows, healthcare organizations can achieve significant reductions in readmission rates, saving time, resources, and money.
Incorporating data-driven patient engagement tools can have a transformative impact on care teams, leading to superior patient outcomes and reduced costs. Our Big Data framework provides a powerful foundation to optimize care delivery by enabling precision medicine, ensuring the right treatment is administered to the right patient at the right time. Our cutting-edge analytics engine leverages multiple simulations to identify the types and timing of interventions that will yield optimal results.
Big Data is invaluable in analyzing patient characteristics, treatment outcomes, and associated costs to identify the most clinically and cost-effective treatments, thereby influencing provider behavior. By utilizing advanced segmentation and predictive modeling, it enables proactive identification of individuals who would benefit from preventative care or lifestyle changes. Furthermore, it facilitates broad-scale disease profiling, enabling the identification of predictive events and support for prevention initiatives. Our fraud prevention algorithms provide payers with the ability to authorize claims in almost real-time, leading to faster care and reduced operational overhead.
The average EHR and health risk assessment can only provide a limited amount of information, making it challenging for care teams to engage patients with personalized care. Equabit's cutting-edge data-driven platform provides a complete 360° view of the patient by integrating social data, demographics, and customer preferences. This comprehensive approach helps care teams better understand a patient's motivations, leading to targeted segmentations for effective patient engagement campaigns.
Our platform provides a unified visual dashboard that aggregates massive quantities of patient data, enabling care teams to anticipate patients' needs and engage them in a more meaningful and personalized way. This level of insight ensures that patients receive the right care at the right time, leading to improved health outcomes and higher patient satisfaction.