Author: Victoria Bucci

Facts About 2022 Medicare Advantage Plans

We find it fascinating how the Medicare Advantage industry changed exponentially in the past decade.

With Medicare Advantage Plans now being a primary partner, we have put together this infographic based on reports provided by KFF Reporting and CMS to show you what to expect from Medicare Advantage in 2022.

With an all-inclusive approach, HealthAxis helps Medicare Advantage Plans grow and overcome many challenges that are unique to their business.

Contact us today to see how HealthAxis can assist with your plan’s needs.[/vc_column_text][/vc_column][/vc_row]

HealthAxis Sponsoring & In-Person at RISE National

HealthAxis is exhibiting at RISE National 2022.

Date: March 7- 9, 2022

HealthAxis will be featuring the benefits of our Medicare Advantage Solutions incorporated within our flagship solution, HxOne. It encompasses next-generation technology, comprehensive third-party services, and advanced analytics to help health plans thrive in a growing and challenging environment. We look forward to connecting in person, talking with those wanting to enhance their operations, and partnering to make a difference in healthcare. Visit us at our booth or contact us ahead of time to schedule a meeting at the event. 

HealthAxis Receives Growth Equity Investment from Revelstoke Capital Partners

Investment enhances HealthAxis’ position as a leading Core Administrative Processing Solutions partner for value-based healthcare payors and risk-bearing organizations


TAMPA, FL, January 10, 2021 – Revelstoke Capital Partners (“Revelstoke”), a leading private equity firm focused on investing in healthcare companies, today announced a growth investment in HealthAxis Group, LLC. (“HealthAxis”). HealthAxis delivers highly automated, next-generation Core Administrative Processing Solutions (“CAPS”), advanced analytics capabilities, and tech-forward services to healthcare payors.

HealthAxis empowers healthcare payors and other risk-bearing organizations to accurately and efficiently process claims, administer benefits, manage providers, enroll participants, and support value-based contracts through mission-critical software and services. HxOne, HealthAxis’ flagship solution, offers scalability, reliability, and unique data-driven insights which promote administrative efficiency and create substantial value for customers.

“HealthAxis and Revelstoke understand there is an urgent need to digitalize and promote efficiency within our healthcare system. We will use this significant new capital to drive growth through targeted product innovation and investment in our team, all while maintaining our focus on customers. We are excited by this new partnership, and I am deeply grateful to our employees for their years of hard work and dedication. I also thank our customers, who, through their loyalty and partnership, have positioned us for this transformative growth opportunity,” said Shilen Patel, Founder & CEO of HealthAxis.

“HealthAxis is at the center of the rapid shift to value-based care,” said Russell Cassella, Managing Partner at Revelstoke, “and we look forward to further solidifying its position as a leading CAPS provider for value-based plans. Led by Shilen and the exceptional management team, and with Revelstoke’s extensive healthcare and technology experience, HealthAxis is well-positioned to greatly accelerate growth, develop new capabilities, gain market share and continue innovating in the most mission-critical area of payor IT.”

“Revelstoke is excited to work alongside HealthAxis’ management team to pursue complementary acquisitions to broaden the company’s solution suite and better serve its customers,” said Cy Barton-Dobenin, Principal at Revelstoke. “This significant investment will allow the company to enrich and extend its care management, payment integrity, and AI-driven automation capabilities for HealthAxis customers.”

McGuireWoods LLP acted as legal counsel to Revelstoke. Shumaker, Loop & Kendrick LLP acted as legal advisors to HealthAxis. The terms of the transaction were not disclosed.

 

About HealthAxis

HealthAxis is a leading provider of modern Core Administrative Processing Solutions and related software and services to healthcare payors. We offer our clients scalable and flexible solutions for their most complex challenges. Our next-generation enterprise solution suite, HxOne, is a comprehensive healthcare management solution that combines our HxPro, core benefits administration software platform, HxLogic, data-driven analytics tools, and HxOps, tech-enabled business process outsourcing capabilities under one unified offering. These solutions combine to make HealthAxis the leading partner for payors seeking reliability, innovation, and efficiency across their most mission-critical business functions. Visit HealthAxis.com for more information.

About Revelstoke

Revelstoke (www.revelstokecapital.com) is a private equity firm formed by experienced investors who focus on building industry-leading companies in the healthcare services and healthcare technology sectors. Revelstoke partners with entrepreneurs and management teams to execute on a disciplined organic and acquisition growth strategy as it strives to build exceptional companies. Revelstoke is based in Denver, Colorado and has approximately $4 billion of assets under management, which includes uncalled capital commitments made to Revelstoke-managed vehicles. Since the firm’s inception in 2013, Revelstoke has completed 135 acquisitions, which includes 24 platform companies and 111 add-on acquisitions.

Contact:
Lambert & Co.
Caroline Luz
203-656-2829
cluz@lambert.com

Alicia Sands Talks About Her Experiences in Compliance

This month, we speak with Alicia Sands, Compliance Improvement Coordinator about compliance operations and upcoming initiatives.

What does an average day look like for you / your team?    

It is an exciting time to be working in Compliance at HealthAxis. The compliance department provides oversight of all functional areas. We ensure that operations comply with HealthAxis, Medicare, and other agency regulatory standards. Our workdays are full of various activities across the Compliance spectrum. Currently, daily routines include filing documents with numerous Secretary of State offices for our licensure; gathering documentation for client audits, and managing evidence submitted for upcoming HITRUST and SOC 1/SOC 2 assessments.  

What wins or challenges have you/your department recently had?  

One of the biggest challenges has been a lack of access to historical department and operational documentation.  However, an impactful win has been working with other departments to gather information and insight to build the document library for future Compliance KPIs, policies & procedures, training, and other guidance materials. The opportunity to speak with subject matter experts across the HealthAxis universe has fostered ongoing collaborative relationships.  

Are there any new developments in your department or on your team we should know about?   

The compliance department is pursuing a HITRUST certification to elevate the organization’s security framework to meet nationally and federally recognized security standards. Obtaining HITRUST certification will be critical in protecting against cybersecurity threats and will provide an added benefit for our clients. 

What have you learned from a client, partner, or coworker that has made an impact on our business?   

My compliance team members have been great at challenging me to expand my professional horizon. Through projects and task shifts, I’ve been able to add a diverse set of regulatory knowledge and skills to my professional repertoire. As an eternal student, it has been rewarding to engage in new endeavors and develop proficiencies.   

What do you value most about our culture at HealthAxis Group?    

I value HealthAxis’ caring culture. Since being here, I have had the pleasure of working for managers that care as much about my personal state of being as they do about my professional growth and productivity. There is a generous sharing of their tremendous years of knowledge and experience while also valuing the skills and expertise that I offer

Heather Hackwell Shares Department Duties

This month we chat with Heather Hackwell, Senior Manager Operations about her department and what their daily activities include. 

Tell us about your department/team – what/who do they support and how?   

My team uses the Insur-Image products for data entry of Health Care Finance Administration (HCFA), Uniform Billing (UB), and Dental claim forms. We provide this service for all onshore customers and Medicare plans. We also assist the Enrollment Department with the Medicare enrollment applications by entering the data into the Member Enrollment Portal.

 What does an average day look like for you / your team?    

The HealthOps data entry team receives thousands of claims to process daily. They are scanned in our mailroom or by our clients. We perform page identification, data entry, and audits of these claims. 95% must be processed within 24 hours of the received date to meet our Service Level Agreement (SLAs).   

 Are there any new developments in your department or on your team we should know about?   

My department has been working hard to prepare for the Annual Election Period (AEP). For the last six weeks, we have been training seasonal team members to be equipped to handle the increase in enrollment applications we get during this time.   

 What have you learned from a client, partner, or coworker that has made an impact on our business?   

I have worked closely with many different departments and team members throughout my years with the company. The excellent customer service they all provide for our customers has a significant impact on our business.  

 What has been your favorite memory so far with HealthAxis?    

The times I have been able to learn from others within the company or help others gain knowledge.   

Importance of Analytics for ACOs to Achieve Shared Savings

ACOs across the country are in varying stages of data-usage. Those who are invested in analytics for ACOs are seeing the quality improvement and cost reduction it has to offer. Data analytics allows ACOs to pull information from a variety of sources to optimize care for their beneficiaries. From real-time tracking to risk analysis, health IT is strengthening the ACO market for both patients and taxpayers.

The Next Generation of The ACO Market

The Next Generation Accountable Care Organization (NGACO) Model has taken on data analytics and other health IT tools and the results have been nothing short of promising. The NGACO Model involves the highest levels of risk of any ACO initiative offered by CMS. As a result, they have almost total financial responsibility for outcomes and have no minimum loss requirements.

Data Analytics Delivers Cost Savings

However, there is a bright side to these high financial stakes. They highlight the need for data analytics and predictive tools to identify opportunities to reduce unnecessary spending while improving the quality of care. The incorporation of health IT has allowed the ACO market to track utilization and manage financial risk, resulting in significantly improved care coordination and chronic disease management.

According to CMS, beneficiaries receiving care within an NGACO experienced 1.7 fewer inpatient hospital days per month in comparison to non-NGACO beneficiaries, as well as 15.6 fewer nonhospital evaluation and management visits per month. A 12% increase in the number of annual wellness visits reflects improved care quality.

The Bright Future of Health IT 

The promising results of NGACOs first performance year show us that they succeed under two-sided risk. The ACOs in this model are delivering value and providing quality care to patients and taxpayers, results that are achievable for other ACOs. After adjusting for shared savings/loss payments, ACO spending was reduced by $62 million.

 

A conversation with Leigh Ann Grey, OBIEE Developer

This month HealthAxis sits down with Leigh Ann Grey, OBIEE Developer. Leigh Ann talks about her department, challenges she has faced, and what she enjoys at HealthAxis.


Tell us about your department/team – what/who do they support and how?  

I am a member of the Oracle Business Intelligence Enterprise Edition (OBIEE) development team. Our team members perform tasks that ensure our tools and solutions are ready to support the healthcare market needs. Our team designs and develops all OBIEE solutions within the Administration tool. We create and maintain OBIEE reports and work closely with Business Analysts and Extract transfer and load (ETL) developers to ensure our solutions align with the business needs of our valued customers.

What wins or challenges have you/your department recently had? 

A recent challenge that turned into a win was when I recently had the opportunity to learn a new reporting tool. Client requirements dictated the development of their current reports into another business intelligence tool. Although it was challenging, I took the opportunity to increase my knowledge and skills. After the project was complete, I felt confident in the new skill I had acquired.

There have also been challenges requiring the development of “out of the box” solutions. I particularly like being assigned and tackling these challenges when they increase my knowledge and abilities.

What have you learned from a client, partner, or coworker that has made an impact? 

I especially enjoy working with the Wounded Warrior Project (WWP) who does so much to help our warriors. We provide data and analytics to track treatment progress, patient participation, and other metrics that help improve their programs. WWP and their partner medical centers across the country use our analytics to find better ways to help our wounded warriors. Sometimes, in the day-to-day tasks, it is easy to forget that the data, analytics, and reports we provide are making an impactful difference in the health and lives of many.

What has been your favorite memory so far with HealthAxis? 

Perhaps my favorite memory was when the Analytics Partners (AP) team met Shilen Patel, CEO of HealthAxis, for the first time in St. Augustine, FL. Meeting Shilen and hearing about his plans for HealthAxis was reassuring. Understanding long-term goals and how AP would fit into the plans created excitement about the upcoming transition. The goals included providing solutions and services to the healthcare industry to make patients healthier while reducing healthcare costs. I found his philosophy of Healthcare Rebooted to be very inspiring and was ready to join this innovative team.

Predictive Analytics Reduces Healthcare Costs and Improves Quality of Care…Definitively.

Reduce Costs with Predictive Analytics

There has been a paradigm shift towards outcome and value-based payment initiatives in healthcare. This has created a push to utilize health data and predictive analytics to improve patient care and optimize information processing. From cost savings to risk management, health information technology has been revolutionizing the field of healthcare management.

Insights Are Lurking in Those Databases 

Healthcare systems are becoming increasingly data-reliant in this technological revolution. With more access to aggregated data, it can be analyzed as a whole to allow an efficient allocation of resources. Lurking in these databases is information on systemic wastes of resources and health trends of populations. Health systems can track patient outcomes and individual practitioner performance in real-time, and even identify people at risk for chronic diseases.

Reduced Costs for Payers and Providers

In addition to healthcare systems, healthcare payer and provider organizations are employing predictive analytics to optimize their practices. In 2019, 61% of executives used technology within their organizations (SOA). Those who weren’t stated that they plan to do so in the next five years.

Of those who have been using predictive analytics, 42% reported reduced costs and 39% reported improved patient satisfaction as a direct result of its implementation. These executives plan to increase their investment in predictive analytics and expect to save 15% or more over the next five years.

One thing payers and providers both agree on is that predictive analytics is critical to the future of their business. The two most desired outcomes executives cited – cost reduction and patient satisfaction – were recorded as the top two actual seen results. As 2021 comes to an end with record-breaking data analytics utilization rates, we can only anticipate a steady increase from here.

3 Keys to Developing a Sound Data Quality Strategy : Part 3

Data quality must be at the forefront of any data warehouse and analytics project to guarantee validity and value within the information you receive.

The key is to focus on three main areas to build a solid data quality best practice standard.

The three main areas of a successful data quality strategy include:

  1. Data Terminology
  2. Data Governance
  3. Data Profiling

Now that we’ve discussed the importance of a sound data governance foundation and data terminology in parts 1 and 2 of this blog series, today we will dive into the MOST critical aspect of data quality…data profiling.

What Exactly Is Data Profiling? 

Data profiling is the process of examining data from the source, collecting statistics, and creating detailed summaries of that data. A detailed analysis of the data source must happen to produce these summaries. Like it or not, you can’t trust copybooks, data models, or source system experts. Regardless of how hard we may try, errors inevitably find their way into our systems, resulting in poor data quality. You must know your data before you can fix it.

Why Is Data Profiling So Important? 

Data profiling is vital because data processing and trusted analysis cannot happen without it. When data profiling starts off a project, it can significantly shorten the development cycle by identifying source system data anomalies and accelerates an understanding of source system data. Data profiling should be the best practice at the start to discover if data is suitable for analysis—and make a “go / no go” decision on the project.

Data warehouse and business intelligence projects depend on data profiling to uncover data-quality issues and determine corrections needed during the extract-transform-load (ETL) process. Data Profiling can also highlight problem sources and identifies the root behind the problem (i.e. user inputs, errors in interfaces, and data corruption). When profiling the data, analysts review the structure, check formats, mathematical equations (min, max, and sum) and delve into content by looking at individual data records to discover errors, analyze the completeness of data and investigate the relationship of the data between tables, spreadsheets, and other sources.

What Is the Best Practice for Data Profiling? 

Like most things in life, there are numerous ways to accomplish this. The old way (also known as the long way) required a skilled resource to manually query data. The new way (and our recommendation) is to utilize data profiling software. For our projects, we use the Oracle Enterprise Data Quality Profile and Audit software product. With advanced data profiling software, you increase the data profiling speed. In addition to saving time and money, it also allows your project to move forward with sound, reliable data. Data profiling software also creates a common repository utilized by the entire team. Finally, it provides a more thorough analysis of the data sources compared to manual processes that only query a subset of the data.

Data Profiling, Data Terminology, And Data Governance; The Key to Real Data Quality 

If someone asked if your data is sound, would you say yes? What if I asked you to bet your job on it? I bet you paused before answering, didn’t you? A robust data quality process involving data profiling, data terminology standardization, and data governance is the only way to overcome skepticism and distrust in your data. Using these three data quality techniques will have you answering, “yes” in no time at all.

 

 

Nicole Harra Shares Human Resources Efforts

This month HealthAxis is excited to feature Nicole Harra from our Human Resources department. Nicole discusses the strides her department is making to help grow HealthAxis’ people-centric culture. She details daily experiences, upcoming events, and what she values about our company culture.

Tell us about your department.

The Human Resources department supports every individual within the organization. Our team is responsible for the employee life cycle (i.e., talent acquisition, onboarding, training and development, retention, and separation). As the HR Generalist, I am one of five team members. The remaining HR team consists of the HR Director, HR Manager, Talent Acquisition Specialist, Learning and Development Specialist.

What does an average day look like for you / your team? 

The average day is a little different for every team member. However, our work is always interconnected to make HealthAxis the best place to work.

We develop enticing offers, a competitive benefits package, and focus on building an inviting culture to attract top resources to HealthAxis. Our department pulls salary bands for open requisition, evaluates the benefits market annually to ensure we are providing the best offerings, and follows top trends to stay competitive. When we recruit from the talent pool, we look for the best of the best, but most importantly we look for an individual that can identify with our core values and be a great fit for the team/organization.

Our goal is to make the new employee experience as seamless and stress-free as possible. We have developed a comprehensive and inclusive onboarding program to make everyone feel welcomed and empowered. Within the employee journey here at HealthAxis, we are always encouraging growth and development with continuous education, goal setting, and career path development. We retain our top talent by continuously providing employees with the opportunity for advancement.

Are you looking forward to any upcoming events?

To continue making HealthAxis a better place to work, we remain focused on achieving our 2021 goals. One goal we focused on was the development of an employee recognition program. The Core Value Champions Recognition Program launched in June of 2021. Each month two stellar employees are recognized for their contributions and exemplifying one of our seven core values.

I am looking forward to the August Q3 meeting where two Core Value Champion winners will be announced live on our new webinar platform. The new platform allows every attendee to participate with live-action icons. These icons show support and praise for the nominated and Core Value Champion winners.

Are there any new developments in your department or on your team?

Since pivoting from in-office work during the pandemic, our team has been focused on developing our hybrid-work model. An in-house hoteling software is being developed for our physical office space with work-from-home surveys and educational tools released to all employees. As we study the hybrid-work model through data collection and beta testing, we gain valuable insights on what improvements can be made to continually enhance the employee experience at HealthAxis.

What do you value most about our culture at HealthAxis Group?

HealthAxis has a people-centric culture that values the happiness of employees as much as the bottom line. The organization understands it’s the employees who make HealthAxis successful.