Health Plans

Ensure accurate, reliable patient data across your operations

Enhance diagnosis specificity with ICD-10-CM and HCC codes to improve workflows and member care.

Challenges

Inconsistent documentation impedes payer-provider collaboration

Dirty clinical data creates discrepancies in the information visible to payers and providers. While payers often have insights into members with chronic conditions, key details needed for reimbursement and Centers for Medicare & Medicaid Services (CMS) reporting can get lost in the problem list when high-risk patients see multiple clinicians. This can result in payers requesting overburdened providers to recapture missing information, leading to operational inefficiencies and unmet CMS requirements.

Poor quality data impacts risk management and the success of value-based plans

Patient data gathered from various health information systems is often inconsistent and full of gaps. Frequent code set updates and evolving regulations add complexity, requiring manual processes and labor-intensive workflows that divert resources from high-value activities. Without data quality management tools to streamline information clean up, payers may inaccurately report patient disease burden, leading to lower reimbursement, care gaps, and dissatisfied members.

Leverage technology built on the terminology and coding in all major EHRs

01

Enhance collaboration between payers and providers

Ensure accurate clinical data exchange with consistency across systems
Streamline HCC capture and identification for precise Risk Adjustment Factor (RAF) scores
Improve risk adjustment processes for efficient reimbursements

02

Access precise and advanced specialized terminology

Access a library of 5+ million unique IMO Health terms mapped to major global coding systems (ICD-9-CM, ICD-10-CM, SNOMED CT® US Edition, CMS HCC & RxHCC, SNODENT, DSM-5-TR® & DC: 0-5, ICD-O-3*, Mondo/OMIM*) *in development 
Leverage complete and reliable clinical detail to support value-based care (VBC) initiatives
Ensure compliance with regulatory standards with content updated 5x per year

03

Improve data quality operations

Efficiently manage large volumes of value sets and related clinical patient data
Standardize disparate clinical data from diverse systems into unified IMO Health vocabulary
Bridge the gap between free text and structured data

SNOMED and SNOMED CT® are registered trademarks of SNOMED International.

DSM-5® is a registered trademark of the American Psychiatric Association, and are used with permission herein.

HOW WE HELP

Built on the same clinical terminology and coding used by 89% of US clinicians at the point of care, IMO Health solutions enhance clinical data quality to streamline risk adjustment management, support VBC initiatives, and maximize reimbursement.

Meaningful insights start with quality data

Enable more precise, accurate, and consistent data and value set definitions with IMO Health’s industry-leading clinical terminology and reference data sets

Reduce your team’s HIT burden with accurate matching, data validation, and streamlined value set creation and management

Ensure semantic interoperability for diagnosis, procedure, medication, and lab data across disparate systems and sources

Process data efficiently with integrated APIs, applications, and file management to ingest, normalize, map, group, and manage data quality

Latest Resources

What health tech gets wrong about clinical NLP – and how to get it right

IMO Health’s Rajiv Haravu joined a recent xCures podcast episode to share how clinical NLP can help solve real problems in health...

Article

HCC coding 101: Understanding Hierarchical Condition Category coding

As more organizations shift to value-based care, precise HCC coding is critical for timely, accurate reimbursement and high-quality patient care.

RAF Scores 101: Understanding risk adjustment coding

Master risk adjustment coding and learn how accurate RAF scores and HCC capture can improve reimbursement and value-based care. 

Ready to improve your data and analytics with IMO Health solutions? Let’s talk.

Our team is eager to learn about your organization and build a strategy together.

POINT OF CARE WORKFLOW

DATA QUALITY MANAGEMENT

PROBLEMS WE SOLVE