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Applying Intelligence. Revealing Insights. Accelerating Value.

SOLUTIONS OVERVIEW

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“The efficiencies Apixio brings to our reviews are just incredible. Their machine learning technology leads you to the right information you need for coding.”Andrew Bloschichak MD, MBASenior Medical Director, Government ProgramsCAPITAL BLUE CROSS

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Healthcare has a data problem, and it’s costing the industry billions

Patient data can help create an affordable and quality care experience.

Every day, millions of patient charts are updated with new data: a new disease, medication, or treatment plan.

This data is an incredibly valuable resource for healthcare organizations. When providers and payers can ex-

tract actionable insights from their data, they can improve the patient experience. Through the power of these

data insights, healthcare organizaations can deliver more effective, affordable, and personalized care.

Organizations struggle to unlock actionable insights from their data.

Providers and payers have a difficult time extracting insights from unstructured text, which makes up 80%

of all healthcare data. This data comes in many different formats and is stored across a variety of systems,

causing access and integration issues. Because of these challenges, patient data is often underutilized in the

provision of care.

Intelligent analysis of data can help create affordable, quality care.

Apixio saw the need for a technology capable of using machine learning (ML) to extract actionable insights

from documents—so we built an industry-leading platform that can do just that. Our AI platform uses the pow-

er of ML to access, analyze, and generate insights from patient data. We empower organizations to learn from

their valuable healthcare data, and use it to improve operations and patient care.

HEALTHCARE’S DATA PROBLEM

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The Apixio difference: Using data to solve the challenges of healthcare

We built a platform to access, analyze, & generate insights from unstructured healthcare data.

Apixio uses machine learning to analyze patient data,

ultimately enabling better decision making for quality

healthcare. Our platform uses a secure process to ex-

tract and generate insights from documents, images,

billing claims, and other data sources from our cus-

tomers. This data is transmitted to the Apixio platform,

then tracked through each stage of data acquisition,

processing, analysis, and insight generation.

Our AI platform continuously learns & improves as it receives feedback.

Apixio’s platform is constantly learning. Our data

scientists and engineers built a proprietary infrastruc-

ture to develop, refine, and enhance machine learning

algorithms using large datasets and expert feedback.

Each time an Apixio platform user makes a decision, it

improves the accuracy of its results.

Apixio’s InfoStream can extract, load, and transform text, PDF, and TIFF documents such as electronic health records (e.g., Epic, Cerner, Allscripts), medical and prescription claims, lab results, and other patient and provider files.

InfoStream enables better access to relevant data.

Apixio InfoStream

THE APIXIO DIFFERENCE

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How we do it...

1. Data AcquisitionApixio securely acquires data from electronic sources and transmits the files to its Data Loader.

2. Data ProcessingApixio loads, validates, and processes data, then turns data in images into machine-readable text.

3. Data AnalysisApixio analyzes data and creates individual care summaries for each patient.

4. Data InsightsApixio uses proprietary data classifiers and predictive models to generate insights from care summaries.

THE APIXIO DIFFERENCE

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Proven risk adjustment results with market-leading AI

Manual coding and unproven technology solutions don’t capture the full truth about your population’s risk, jeopardizing your reporting accuracy – putting your organization at financial and compliance risk. Apixio’s AI-powered coding application and service is trusted by leading Medicare Advantage organizations, Affordable Care Act plans, and Medicare ACOs to achieve accurate, efficient first-pass and second-pass coding results at scale.

Scalable, flexible coding & QA solutions

Whether you manage coding with in-house reviewers or rely on vendor coders, Apixio’s HCC Identifier solution can

support your risk adjustment program needs. Our application serves up targeted AI-predicted coding opportunities

for review, reducing coding time by 80% and increasing coding accuracy by 20%. Flexible project management and

workflow features empower you to run and optimize projects according to your organization’s specific guidelines.

And if you get an unexpected batch of charts on a tight deadline, our technology and coding teams can scale

quickly to support your program needs.

APIXIO’S SOLUTIONS

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Maximize your coding accuracy and reduce audit risk

In today’s regulatory environment, risk adjustment teams are under pressure to ensure their retrospective coding decisions are accurate and well-supported by clinical documentation. But auditing every chart is time-consuming, complicated, and costly. AI can lighten the review load while minimizing your organization’s risk during RADV audits.

Protect your organization by working smarter with AI

Apixio’s HCC Auditor solution reduces the compliance burden on your coding team by analyzing coding decisions and

flagging HCCs that may be missing appropriate documentation. Instead of reading through thousands of pages of charts,

your team can focus on reviewing codes that pose the biggest potential audit risk, helping reduce your organization’s

financial and compliance risk.

“By using Apixio, we’re improving our auditing bandwidth and enhancing the ability of our coders to focus on other chart audits and projects we couldn’t do before.”

JoAnn Hayden Supervisor of Quality Improvement Programs SCRIPPS HEALTH PLAN SERVICES

APIXIO’S SOLUTIONS

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Accurate risk adjustment is critical for ACOs to succeed in the Medicare Shared Savings Program (MSSP). To maximize shared savings, your population’s risk must be fully represented on claims. But manually performing retrospective chart reviews, developing patient suspect lists to close gaps, and identifying provider improvement areas is time-consuming, expensive, and often ineffective.

Timely, reliable analytics to improve patient risk capture

Apixio’s Risk Adjustment for Medicare ACOs solution uses artificial intelligence (AI) to identify risk-adjusting

patient conditions that haven’t been properly documented at the point of care or coded on claims, increasing your

ACO’s risk capture for Medicare patients. Our analytics solution supports targeted clerical error reopenings with

your MAC, patient visit chase list development, and physician education programs to improve coding performance.

APIXIO’S SOLUTIONS

Equip your ACO for MSSP risk adjustment success

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Improve the accuracy of your quality abstraction process with AI

HEDIS and Stars are being adopted by plans and providers nationwide to benchmark care quality. . For many measures, evidence of compliance resides in medical charts, not in administrative or billing data. Consequently, provider groups must hunt for supporting evidence in electronic medical records or provide proof that a procedure or service was completed. This process is time consuming, costly, and prone to human error, which can negatively impact quality program performance

The fastest way to find clinical facts for quality reporting

Apixio’s Quality Identifier solution uses AI algorithms to identify clinical data needed for quality program reporting.

Instead of reading through hundreds of pages to find relevant information, abstractors are pointed to specific pages with

predicted facts, expediting the review process and increasing quality measurement accuracy. With a more accurate view

of performance, providers can understand where they have true care gaps, not just reporting gaps, and make strategic

improvements accordingly.

APIXIO’S SOLUTIONS

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Whether you have an internal team of data analysts or do all the number-crunching yourself, Apixio Insights take the pressure off your team to extract meaningful intelligence from messy healthcare data. Our analytic services support a smarter approach to patient suspecting, provider education, and compliance, and seamlessly plug into your existing workflows.

Analytic services to drive more timely and actionable insights

APIXIO’S SOLUTIONS

Prospective Analytics

Running a paper-based prospective risk program? Apixio’s Prospective Analytics solution

provides the same targeted AI-generated condition suspects and supporting evidence as Pro-

spective Insights, but delivered a simple report you can integrate into your existing direct mail

or fax-based programs to improve condition capture at the point of care.

Documentation Gap Report

Providers serving MA and ACA patients don’t always document patient encounters with HCC

coding in mind. Apixio’s Documentation Gap Report identifies encounter notes with attributed

HCCs lacking critical documentation elements required for submission. Gaps are attributed

to specific providers and include missing elements and dates of service to support physician

outreach and training programs.

Zero Evidence Report

Condition codes are often submitted from a physician office without the necessary support-

ing evidence, which puts health plans and providers at compliance risk. Apixio’s Zero Evidence

Report identifies codes submitted to CMS on claims without evidence in the source encoun-

ter note to inform documentation improvements or deletion.physician outreach and training

programs.

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Increase In Coder Productivity

More Supported HCCs

Reduction in Coding Time

4-7X 20% 80%

Accelerate your risk and quality program results

Onboarding and data extraction made easy

With Apixio, the implementation process is simple,

fast, and at no additional cost. Our data integration

experts work with your team to load charts, claims,

patient and provider files, labs, and other data sourc-

es into our platform for processing. We support data

extracts from all major EHRs, including Epic, Cerner,

and Allscripts; PDF or TIFF files from your chart chase

vendor or internal warehouse; and electronic files

without special formatting required. Once the data is

validated and loaded, we deliver coding or abstraction

opportunities in weeks, not months.

Tested technology, proven value

Traditional coding methods are slow, inaccurate, and

put organizations at risk for submitting codes with-

out sufficient evidence. Apixio conducted the largest

known study to compare manual coding and AI-pow-

ered coding processes. The results demonstrated the

unparalleled advantage of AI. With AI, coders experi-

enced a 4–7X increase in productivity, and found 20%

more supported HCCs than coders manually

reviewing charts.

“The coding team was wonderful to work with, and incorporated our specific coding guidelines when working on our project. When they noticed a trend in what we were rejecting, they shared a Coding Clinic we were unaware of for clarification on how to code the scenarios.”

Josh Weisbrod VP of Risk Adjustment NETWORK HEALTH

APIXIO’S RESULTS

THE FUTURE OF HEALTHCARE

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The future of healthcare delivery

Building clinical solutions that will revolutionize care

Imagine a world in which technology can create individual health profiles from available data and use re-

al-world clinical evidence to create truly personalized and affordable care. That’s the world Apixio is building

right now.

Apixio’s patented AI platform has already advanced the risk adjustment and quality measurement process.

We’re currently developing AI-powered clinical solutions that will help providers and payers deliver more effec-

tive, timely healthcare.

Powering the future with advanced intelligence

We all want better healthcare. At Apixio, we believe the key is using data insights. With innovations in machine

learning technology, we can augment the ability to read, analyze, and use patient information for more effec-

tive healthcare.

Roughly 80% of healthcare data is unstructured and underused. Apixio helps organizations use their data

to better understand patient health. This ultimately translates into improved care delivery, lower costs, and

streamlined processes. It’s time for serious change in healthcare. With Apixio, data insights will lead the way.

Average Project ROI

Reduction in Coding Time

Patient Charts Processed

49National and Regional

Customers

4-7x 80%

14M

Our AI-powered solutions are built from a wealth of experience

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Improving healthcare outcomes requires access to the right data at the right time. Apixio is advancing value-based care with data-driven intelligence and analytics. Our AI-powered insights unlock actionable information from administrative and unstructured clinical data. The results drive better decision-making and a smarter approach to healthcare.

Want to learn more about our AI analytics solutions for value-based care? Get in touch.

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Apixio ©Copyright 2020. All rights reserved.

P: (877) 427-4946 E: info@apixio.com @apixio

1850 Gateway Drive, Suite 300 San Mateo, CA 94404