Clinical Insights

Peak is Now Episource – Enhanced Capabilities for Medicare, Commercial and Medicaid Health Plans

Rooted in complex statistical methods, Risk Adjustment ensures that health plans are accurately compensated based on their members’ health statuses. The process not only guarantees payment integrity, it also provides a view of population health that can help improve care delivery efforts as well as quality ratings.

Nationally, Episource’s clinical practitioner network now comprises 750 Nurse Practitioners, Physician Assistants and Physicians. This network represents a substantial increase in prospective capabilities as well as in Episource’s overall ability to provide holistic Risk Adjustment and Quality Improvement solutions to health plans across the country.

Utilizing a unique targeting methodology to select members who are disconnected from the delivery system (those with significant gaps in quality metrics or with persistent HCC conditions), prospective health assessments pinpoint members who will benefit most from a personalized visit. For such members, these health assessments promote a higher quality of life and ensure the delivery of high-quality care. For health plans, the visits ensure the right diagnoses are captured, thereby improving documentation.

Driven to provide clients with elegantly simple data, tools, and insights, Episource is now better positioned to help health plans across the nation navigate the complexity and challenges of the healthcare industry.

With the shift toward value-based care and unprecedented marketplace disruption, strong Risk Adjustment and Quality Improvement strategies will be key for health plans to continue providing accessible and affordable insurance. Accurate Risk Adjustment both guarantees revenue accuracy while also providing a view of population health that can help improve care delivery as well as Quality Improvement efforts.

For health plans that already engage in retrospective chart review, this clinical services offering can complement their programs by capturing missing member diagnoses as well as in closing both risk and quality gaps in care. For health plans who have yet to embark on a Risk Adjustment or Quality Improvement program, Episource will draw on its deeply nuanced expertise in RA and Quality regulatory requirements and processes to develop the best strategies to solve their specific challenges. To this end, Episource’s in-house engineering and development teams can build custom solutions for clients based on their specifications.

Available individually, as an end-to-end suite, or in a combination specific to a health plan’s current state of organizational readiness or resource availability, Episource’s services and products include:

  • Medical Record Retrieval and Medical Record Coding (with real-time reporting through the epiConnect online portal)
  • Workflow and analytics platform to identify HCC opportunities and launch RAF campaigns (epiAnalyst)
  • RAPS and EDPS Error Management, Financial Analytics and Submissions (epiEncounter)
  • Clinical Services
  • Prospective Health Assessments
  • Nurse Practitioner Programs
  • Provider Query Services and Training
  • Quality
  • Analytics & Reporting
  • HEDIS Retrieval and Abstraction
  • Care Gap Reporting

Whether a plan has one million members or 10,000, Episource’s resources and expertise can help create, implement and support its Risk Adjustment and Quality initiatives, ensuring its objectives are met.


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider