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Annapolis, Maryland, United States


Organization type

Analytics services vendor for payers

Products implemented

Corepoint Integration Engine with Direct Project, File Exchange, and extensive database transactions. We are currently working on building a FHIR server utilizing Web Services and plan to make that expansion early in 2020.

The customer


Lowering healthcare costs while increasing the quality of care depends on the open and timely flow of clinical and administrative data. When payers and providers use this data to inform workflows, providers can deliver better care at lower costs — thereby increasing value for patients.

Pulse8 is an Annapolis, Maryland-based healthcare analytics and technology company that delivers an unprecedented view into risk adjustment, enabling health plans to achieve the highest financial impact in the ACA Commercial Health Exchanges, Medicare Advantage, Medicaid, and Medicare markets. Their mission? To reimagine data to help people live healthy and independent lives through the execution of sophisticated analytics, predictive techniques, and data collection tools.

Pulse8’s cornerstone platform is called Illumin8. Illumin8 is designed to remove waste, optimize revenue, and deliver innovation within the workflow of a health plan or at-risk provider. The visualization and reporting platform allows risk-bearing entities — health plans and providers with ACA, Medicare Advantage, and Medicaid patients — to address risk adjustment and quality metrics for all government programs through the power of big data, risk adjustment and quality metrics. Pulse8 achieves this by pulling in data from its payer customers and comparing it against algorithms in its Illumin8 platform, and then providing reports back to the customers to help them with risk adjustment and coding.

The challenge

Pulse8 has identified a need to bring in data directly from their provider partners’ EMR systems. Dealing with the volume and complexity of data derived from EMRs is no small challenge, though.

“Some of our customers would like to get out of the business of pulling in their own data and aggregating it because it’s a lot of overhead,” said Jason Setters, Pulse8 EMR Integration Engineer.

For instance, some of Pulse8’s customers wanted to be able to send Consolidated Clinical Document Architecture files (C-CDAs), a structured data format for patient charts, from their provider partners’ EMR systems directly to Pulse8. By matching patient data between the payer and provider, Pulse8 could then provide their payer customers more robust data analytics.

C-CDA documents contain volumes of rich data, but “they’re big, gnarly XML documents that can be thousands of lines long,” Setters said. In addition, the diversity of data formats from EMRs presented a challenge. “There’s a lot of HL7 v2.x, but then there are other standards, like FHIR and CDAs,” Setters explained.

The solution

Pulse8 launched a new solution called Integr8, which facilitates payer-provider collaboration through the automated exchange of patient information. It allows providers to make more informed decisions and provides payers with additional data analytics.

Pulse8 chose Rhapsody as its interoperability partner to help establish a secure avenue into data feeds directly out of providers’ EMR systems. “Corepoint lets us hook right up to the EMRs, match on our customers’ members, and then provide them with additional data analytics,” Setters said. “We’re building up our payer customers’ data by going directly to their partners’ EMR systems, HIEs, and labs and bringing in the data and helping feed our analytics with that.”

With Corepoint Integration Engine, Pulse8 can better handle the complexity and diversity of data formats in the healthcare environment. Using the engine, Pulse8 can bring the C-CDAs in bulk into its data warehouse and run analytics. “You can get all kinds of that data that’s good for risk adjustment and quality,” Setters said.

For instance, Pulse8 can get C-CDA files and use them to compare a list of ICD 10 or CPT codes with Pulse8’s algorithms to see if any codes should be changed. “We’ll provide the data back to our client, and it allows them to make sure they’re coding their charges right or suggest other avenues of care if something’s been missed.” Setters explained. “One of the ways we’re trying to do that, too, is to keep an eye on things like immunizations — when they’re due and have they been done.”

“This is a daily reminder that we have a mission here — more than just crunching data.”

Jason Setters

Pulse8 EMR Integration Engineer

The results

Pulse8 has been able to provide its clients the data they need in the format in which they need it. “However they need us to send the data, we have the capability of doing that because Corepoint will standardize all that into a set of data tables for us to draw from,” Setters said.

He added that the Action Lists in Corepoint are particularly helpful in allowing this data exchange to happen. “That ability to get almost any data format you can imagine, especially that’s used in healthcare, and finding a way to process that and create a normal
outbound that’s all in one happy format that can easily be consumed into our backend structure — that’s incredibly important.”

Another feature that Setters finds powerful is the ability to inline test their code. This is helpful because CDA documents can be more than 7,000 lines long, “So you have to set up very specific parts of the action lists to go in and extract the data you want,” Setters said.

In the midst of analyzing data for their customers, Pulse8 employees never lose sight of the fact that “Every number is a life.”

“This is a daily reminder that we have a mission here — more than just crunching data,” Setters said. “Every one of those data points — what’s the point of collecting it if you’re not helping people get better outcomes from their medical care?

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