Your population health analytics are sophisticated. The gap between identifying a member who needs outreach and completing that outreach — at full-member-population scale, across the measures that move your Star Rating — is where revenue is won or lost.
Request a DemoMedicare Advantage plans compete on Star Ratings and risk adjustment accuracy. Both depend on member engagement, clinical documentation, and care coordination that most plans cannot execute at full-member-population scale. The analytics to identify the gap are sophisticated. The workflow execution layer to close it is the missing piece.
HEDIS measures that move Stars — medication adherence, diabetes care, blood pressure control, colorectal screening — require member contact, appointment scheduling, and clinical follow-through that plan-level care management cannot execute at full-population scale.
Members with chronic conditions present but underdocumented suppress risk adjustment revenue. Closing documentation gaps requires outreach, visit completion, and documentation alignment that internal teams can’t sustain across the full member population.
The members who drive the highest total cost of care are often the hardest to engage proactively. Reaching them before a hospitalization or ED visit requires outreach capacity that case manager caseloads cannot sustain across the full high-risk cohort.
PDC scores for diabetes, hypertension, and cholesterol medications directly affect Star Ratings. Moving PDC scores requires consistent member contact and barrier resolution — cost, pharmacy access, side effects — not just fill reminders that generate no-responses.
Zynix AI is the member outreach and care coordination execution layer between your population health intelligence and your member population. It handles the contact volume, barrier resolution, and documentation workflows that your Stars and risk adjustment programs require but cannot execute manually at scale.
Quality gap reminders, HCC documentation outreach, medication adherence check-ins, and preventive care follow-through executed for every eligible member — not just those a case manager had time to call.
Two-way conversations identify cost, access, transportation, and language barriers in the same interaction where the clinical need is surfaced — and route each barrier to resolution without requiring a second follow-up.
HCC gaps prioritized by revenue impact. Outreach, scheduling, visit completion, and documentation coordinated in sequence. The risk adjustment deadline is a fixed constraint — the execution layer runs to meet it.
ZynPredict surfaces members on a deterioration trajectory before a hospitalization or ED visit. Proactive outreach engages them at the right window — identifying the barriers driving the risk and connecting to chronic care management.