UPMC Health Plan: Health Fidelity Case Study

How HCC Scout helped UPMC discover new risk insights, leading to better revenue capture and higher coder efficiency


UPMC Health Plan, 12th largest MA plan, 4 stars.

The largest nongovernmental employer in Penn., UPMC integrates more than 60,000 employees, 20 hospitals, 500 doctors’ offices and outpatient sites, a more than 2.8-million-member health insurance division, and international and commercial operations.


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Quote HCC Scout completely transforms the process of risk adjustment through its intuitive workflow. By consolidating all essential data points into one managed workflow, we can ensure efficiency, compliance, and accurate and optimal risk capture, affording us the opportunity to spend more time focusing on the quality of care provided to our membership. Quotation Mark
Mary Beth Jenkins
Mary Beth Jenkins
SVP & COO
UPMC Health Plan




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Review UPMC's risk adjustment pilot results

In 2014, UPMC Health Plan, as part of a leadership-sponsored strategic initiative, implemented HCC Scout to help increase accurate RAF capture in compliance with CMS Risk Adjustment guidelines while improving overall coding efficiency.

The health plan, which was already running sophisticated risk adjustment operations, saw remarkable projected return on investment with a study conducted on PY2012 members, including the following incremental results:

HCC per Member Stat
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RPM Stat ....
Coder Productivity Stat

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