For health plans
The #1-rated risk adjustment solution for health plans
Vatica’s unique PCP-centric risk adjustment solution is designed to help health plans, providers and patients achieve better outcomes together. Our prospective solution is driven by the real-time curation and analysis of clinical data, health plan data and analytics of both structured and unstructured data. This enables PCPs to capture conditions with the highest degree of specificity and address gaps in care. By increasing patient engagement and wellness, improving coding accuracy and compliance, and helping identify gaps in care, our healthcare solution ensures that everyone benefits.
How health plans benefit
12%+
Accuracy and specificity
improvement
80%+
Completion rate by
treating PCP
Improved
compliance
Review of documentation
and coding
A solution that PCPs actually use
Unlike other prospective solutions that either work around or frustrate PCPs, Vatica offers a fresh approach that providers actually embrace. Here’s why:
- Designed by physicians for physicians, Vatica’s risk adjustment solution is quick and easy to use.
- Vatica Clinical Consultants and administrative staff provide hands-on support and serve as an extension of the PCP staff.
- Vatica helps PCPs improve patient care.
Hear what our clients have to say.
What makes Vatica different
Comprehensive support
Vatica Clinical Consultants, paired with proprietary technology, work with PCPs to drive more complete and accurate documentation and coding. Our healthcare payer solution also ensures better continuity of care and patient care than a home assessment.
Comprehensive data
Vatica synthesizes EMR and health plan data to create the most comprehensive and complete view of each patient. This data is provided to PCPs at the time of a patient encounter, thereby driving workflow efficiency and enabling PCPs to be more prepared and informed for each visit. As a result, health plans optimize risk adjustment results, providers optimize practice performance and members receive appropriate benefits.
Improved compliance
We review encounters after the Vatica visit to ensure compliance. Our team of AAPC™-certified risk adjustment coders reviews coding and documentation for completeness and accuracy. We identify incorrect codes and educate providers to reinforce learning and ensure accurate coding.
Lines of business
At Vatica, we’ve built successful partnerships with payer organizations of all types and sizes. Because we understand each organization’s unique needs, our solutions are built to optimize performance across every line of business. Regardless of where you take risk, we can support you.
Medicare Advantage
With more than a decade of dedicated focus on the Medicare market, Vatica has built a proven track record of helping Medicare Advantage (MA) plans excel in risk adjustment. Our deep expertise enables us to guide clients through complex challenges, from the transition to CMS-HCC Model V28 to managing the increased scrutiny of legacy risk adjustment models. Trusted by MA plans nationwide, Vatica consistently delivers market-leading results and seamlessly integrates with other risk and quality solutions, offering unmatched flexibility and expertise in the industry.
Medicaid
Vatica helps health plans navigate the complexities of state-specific Medicaid risk adjustment models. Our provider-centric solution for risk adjustment is exceptionally well-suited for the Medicaid market, where quality and accuracy are paramount. Vatica’s platform is built to streamline data capture and improve documentation quality, addressing common Medicaid challenges such as resource constraints and compliance complexities.
Affordable Care Act
For nearly a decade, Vatica has been helping health plans manage the complexities of the Affordable Care Act. By focusing on provider engagement and complete data capture, Vatica ensures accurate diagnosis coding that reflects the true health needs of ACA members. Our member targeting and analytics ensure that health plans are appropriately compensated for taking on high-risk patients.
Recognition
Named Best in KLAS®
three years in a row
2025 marked the third year in a row that we were recognized with the Best in KLAS distinction in the Risk Adjustment Software and Professional Services category.
Hear from our customers
“We’ve advocated that one of our other large payers in the community partner with Vatica so we can use the solution for more of our patients. We’d like to see all the payers in our marketplace use Vatica and look forward to leveraging Vatica as we transition to more value-based care. Our group is very appreciative of Vatica’s efforts, partnership and collaboration.”
General Physician PC, New York
“I find the process to be very easy, and we get valuable information. Vatica collects data from different providers and presents it to us in one place—it’s a one-stop shop.”
Nuestra Clinic, Texas
“For our practice, the first ‘toe in the water’ toward transitioning to value-based care was our contract with Vatica. There was a concerted effort in our organization to make sure that some of the savings that comes from this work is shared with physicians. Physicians were motivated to change. They’re doing a better job of assessing risk, understanding where the higher risk population is and directing services toward that population.”
NEMG, Connecticut
“I’ve been most impressed with Vatica’s ‘at-the-elbow’ customer service. It’s been such an easy process for our clinicians to onboard. The team is willing to come out—even on short notice—to make sure that the clinicians can log on and use the product with a real case. When they’re done, the clinicians have a good understanding of how to use the product to its fullest extent.”
UC Health, Ohio
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Adjust your approach to risk adjustment
Talk to one of our risk adjustment experts today to see how we can help you deliver better performance and stronger compliance while closing gaps in care.