How Population Advyzer Helped Three Health Plans Achieve Significant ROI in Risk Adjustment

Blue Health Intelligence (BHI)


Health plans today want greater internal control of their risk adjustment programs and increased visibility into the risk adjustment process. No longer content to rely on broad-brush chart reviews, provider engagement, and in-home assessments, health plans instead want greater accuracy, efficiency, and transparency in how members are selected and which interventions are deployed.Answering this need, Blue Health Intelligence®’s (BHI®’s) Population Advyzer platform unbundles analytics from interventions. This allows us to recommend what actions to take and what to avoid based solely on data-driven insights. Care and coding gaps are being closed more efficiently; health risks are being more accurately captured; and reimbursement is reflecting the actual risks within a member population. Through a fully transparent methodology, we have helped plans realize as much as a twelve-fold return on investment on medical chart reviews alone.


Our Approach

The Population Advyzer risk adjustment and stratification solution follows a playbook built on best practices and informed by the right analytics. The playbook is designed around proven principles for risk adjustment and intervention:

  • Capture the right data to enable efficiency improvements. Strive for high-quality provider data and capture appropriate feedback from intervention vendors.
  • Take time up front to let analytics inform the best intervention strategy.
  • Take aim with predictive analytics to accurately target providers and guide when – and when not – to take action. Every unnecessary action wastes money.
  • Engage providers with meaningful information on members, gaps, and incentive programs by using tools that integrate into existing workflows.

Measure to improve, because – in the words of the pioneering scientist Lord Kelvin, “If you cannot measure it, you cannot improve it.”


Three Health Plans Get Results

Population Advyzer was employed to improve the efficiency of three health plans’ risk adjustment programs while helping them reach or surpass previous years’ results. While each plan faced unique market dynamics, geographic considerations, and provider affiliations, the Population Advyzer playbook was effective in every case.

A large regional plan completes a thorough chart review

Challenge: This plan had historically invested significant resources into risk adjustment, casting a wide net on chart reviews and using multiple vendors to perform both in- and out-of-area reviews. Plan leaders sought a way to reduce program costs while maximizing risk capture results.


Action: By taking time up front to let analytics inform its intervention strategy, the plan executed a well-thought out, multifaceted approach that maximized results.


Result: Plan leaders credited their team’s efforts and Population Advyzer for a twelve- fold ROI on medical record reviews alone and a six-fold overall ROI, including vendor and internal staffing costs.


A smaller regional plan supports a tight, targeted approach

Challenge: A small non-profit plan with a large share of the state’s Affordable Care Act population took a conservative approach to risk adjustment, with one in-house coder and a defined budget. This plan needed to target the members with the greatest potential for improving risk score accuracy, informed by the knowledge of the best time and method with which to engage them, so as ensure the greatest return within their budget.


Action: The plan focused first on its large, high-impact provider affiliations, which included the largest health system in its market. Because members typically stayed within the single system for all their medical needs, this approach eliminated the need for multiple chart reviews. Further, the plan’s relationship allowed it to access the system’s electronic health record, a less costly and burdensome approach than conducting manual chart reviews. Armed with the right predictive analytics, the plan could then zero in on the members in whom it saw the greatest opportunity for closing gaps.


Result: By leveraging Population Advyzer, the plan achieved a three-fold ROI on its medical records review program.


A regional plan saves more than $1 million in its pilot year

Challenge: A third regional health plan chose Population Advyzer to be the centerpiece of its risk adjustment efforts as it brought the program in-house. This plan needed to get started quickly with a platform that employed the right analytics and workflow programs and minimized learning curve downtime and errors.


Action: The plan approached its first year as a pilot year – with a new staff, processes, and a limited scope of interventions.


Result: By relying on Population Advyzer to inform the best intervention strategies, the plan realized more than $1 million in payment transfer savings.

Different plans, a consistent approach

Every plan is unique, but the principles within the Population Advyzer playbook work equally well in any circumstance. As an analytics company, BHI’s only goal is to provide insights to optimize results and pinpoint where improvement is needed. As data scientists, BHI’s consultants are firmly committed to measurement, transparency, and accuracy.

As a company, BHI is proud to say that we have built a strong partnership with every client, delivering them a solid program and ROI.

Want to learn more about Population Advyzer?

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About Blue Health Intelligence®  (BHI®)

Leveraging the power of claims data from more than 180 million Americans, Blue Health Intelligence (BHI) delivers insights that empower healthcare organizations to improve patient care, reduce costs, and optimize performance. With the largest, most up-to-date, and uniform data set in healthcare, BHI provides an accurate representation of the health profile of commercially insured Americans. Blue Health Intelligence is an independent licensee of the Blue Cross Blue Shield Association and carries the trade name of Health Intelligence Company, LLC. For more information, visit