Driving provider engagement: Light touch, high value strategies

Provider group engagement has become a strategic imperative for many health plans to bridge payer/provider alignment gaps on shared goals. At Reveleer, we provide solutions that effortlessly engage providers to access the data they need and enable them to act on it. From medical record retrieval to prospective suspecting to care gap management, our solutions are designed to deliver measurable outcomes through intelligent automation, seamless workflows, and continuous collaboration.

Specifically, our technology empowers providers through three key solutions: multi-channel medical record retrieval, prospective clinical intelligence, and care gap management. The following sections explain how each of these solutions contributes to a seamless and productive partnership between health plans and provider groups demonstrating the critical need of this collaboration for value-based care success.

Retrieval: Powering provider engagement for better outcomes

Efficient and precise retrieval of medical records is essential for achieving optimal outcomes in prospective risk adjustment, retrospective risk Adjustment, Stars quality, IVA, and MA RADV audits within the complex landscape of healthcare data management. At Reveleer, we’ve built a retrieval product that not only streamlines operations but also transforms provider engagement into a strategic advantage.

Reveleer’s Retrieval Solution is more than a data collection tool, it’s a provider engagement engine. By embedding automation, personalization, and strategic insights into every step of the retrieval process, we help health plans and providers work together to deliver better outcomes.

Reducing provider abrasion through automation

Our retrieval workflows are built to minimize provider abrasion. Typically, this is the fatigue or frustration providers experience due to repetitive or inefficient outreach and data requests and other distractions that takes them away from their clinical work. By leveraging AI, OCR, and NLP, Reveleer automates document ingestion and indexing, eliminating repetitive tasks and reducing manual errors.

• ‍Direct-to-EMR connectivity: Wherever possible, Reveleer connects directly to provider systems, bypassing traditional retrieval bottlenecks‍
• AI voice agents: A conversational AI-powered caller that automates high-volume, low-complexity outreach with human-like voice interaction, enabling scalable, efficient data retrieval while complementing live teams for nuanced follow-ups and issue resolution‍
• Intake queue management: Documents with incomplete identifiers are routed to manual queues, ensuring no data is lost
• Pend management: Retrieval pends are handled through dedicated workflows that resolve issues like non-response or incomplete records without disrupting provider operations or workflows‍
  

Engaging providers where they work

Reveleer’s retrieval solution is designed to meet providers where they are—whether in their EMRs, inboxes, or portals. Our platform supports multi-channel outreach, including phone, fax, email, and secure web uploads, all tailored to provider preferences and historical responsiveness.

• ‍Provider packet configuration: Customized documentation is sent to providers including member lists, authorization forms, and instructions via integrated communication tools to facilitate record retrieval. Additional content can be included via customized preferences, resulting in complete “packets” that personalize the experience between Reveleer customers and their providers.‍
• Secure chart drop: Providers can upload records directly through a drag-and-drop interface, reducing friction and improving turnaround times.
• Outreach optimization: Historical performance data informs outreach strategies, ensuring providers receive communications in the most effective format.‍
• Automated voice agents: Automates high-volume, low-complexity calls to provider sites with clean and complete data, allowing human agents to focus on escalations, follow-ups, and complex cases

Turning retrieval into a strategic engagement channel

Reveleer’s retrieval footprint spans over a hundred thousand providers. This scale presents a unique opportunity to not just collect data, but to build deeper relationships with provider organizations. Within that solution, we are continually working to advance our customer experience in the following ways:

• ‍Feedback loops and education: Data-driven insights are shared with providers to improve documentation habits and coding accuracy.
• Performance dashboards: Providers gain visibility into their retrieval metrics, including RAF impact and gap closure rates, fostering accountability and continuous improvement.‍

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Provider-centric design and usability

Reveleer’s product teams work closely with providers to ensure the retrieval experience is intuitive and aligned with clinical workflows.

• ‍UI and workflow enhancements: Feedback from providers and coders informs design decisions, such as tagging for prioritization and pend visibility.‍
• Role-based permissions: Customizable settings ensure that providers and support teams have access to the tools they need without unnecessary complexity.

As we continue our journey towards one platform, medical record retrieval will continue to be a key pillar of our offering, with a focus on data reuse across projects and increasing capabilities in low-touch, high-value multi-channel reach.

Prospective suspecting aka Clinical Intelligence: Empowering providers with high value suspects at the point of care

In the era of value-based care, provider engagement is the linchpin of success. At Reveleer, our Clinical Intelligence product is redefining how providers interact with data, close care gaps, and drive outcomes. We developed our solution to provide practical insights right in provider workflows, helping facilitate more informed choices and higher-quality care.

Reveleer’s Clinical Intelligence Solution is a transformation engine for providers. By embedding insights directly into provider workflows and unifying diagnosis suspecting and validation, we empower clinicians to deliver better care, faster without abrasion.

A unified experience for real-time clinical action

Reveleer’s Clinical Intelligence Solution is also configurable. It supports both pre-encounter suspecting and post-encounter validation through:

• Access to suspected conditions before patient visits
• Real-time alerts within EHR workflows
• Documentation validation and coding post-visit for compliance and reimbursement accuracy

The technology’s modular design enables toggling features based on customer needs, such as:

• ‍NLP-powered analysis of unstructured data
• HIE and care quality integration for broader data access‍
• Clinical rules engines for structured suspecting
• Point-of-care EHR integrations for seamless provider engagement

Provider engagement without disruption

One of the most powerful aspects of Reveleer’s point of care insights and activation solution is its ability to engage providers without disrupting their workflows. Through native and non-native EHR integrations, providers receive curated insights via:

• ‍Epic BPA alerts
• Standalone portals or overlays‍
• Standardized data files that can be automatically processed by provider systems

This frictionless delivery accelerates adoption and ensures that provider scan act on insights without toggling between systems.

Driving outcomes through data intelligence

The platform’s AI-powered suspecting and validation capabilities are designed to:

• ‍Capture net-new and previously documented diagnoses from diverse data sources.‍
• Prioritize high-risk patients for outreach and disease management.
• Improve RAF score accuracy by surfacing overlooked HCCs.
• Reduce administrative burden through automation and streamlined workflows.
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Intelligent automation that delivers results

In 2024 alone, Reveleer processed over 1.2 billion pages of clinical data, validated 2.5 million diagnoses, and achieved a 99% accuracy rate using proprietary AI models.

1.2 billion pages of clinical data

Validated 2.5 million diagnoses

Achieved a 99% accuracy rate

Care Gap Manager: Redefining provider group engagement for better outcomes and compliance

In today’s value-based care landscape, provider group engagement is the engine that drives meaningful outcomes. At Reveleer, we’ve taken this to heart with the addition of Novillus’ Care Gap Manager (CGM) to our platform. Together, we’re transforming how health plans and provider groups are enabled to collaborate in critical workflows such as gap management for risk and quality, incentive tracking and member attribution management.

Unified provider group engagement across the care journey

Reveleer’s platform, now enhanced by Novillus, offers a comprehensive, omnichannel provider engagement framework. This includes:

• ‍Real-time workflows for care gap closure and evidence submission‍
• Automated incentive tracking with performance dashboards for provider groups

These capabilities ensure that providers are not just informed but actively participating in care improvement efforts—whether it’s closing gaps, submitting evidence, or tracking incentives.

Member roster management and retrieval

Through Care Gap Manager (CGM), Reveleer enables health plans to manage member rosters and care gaps with precision:‍

• ‍Member roster management is streamlined with real-time updates and drill-down capabilities
• Retrieval workflows are powered by AI modules, which reduce manual chart review by up to 77%, doubling throughput and freeing up clinical resources for complex cases

This results in faster evidence collection, improved RAF scores, and better alignment with HEDIS reporting and Stars improvement programs.

Proactive risk and quality management

Novillus, a Reveleer company, brings prospective risk adjustment and year-round quality management to the forefront of the provider workflow:

• CGMA supports continuous care gap identification, not just seasonal compliance reporting
• AI-driven insights help providers act on gaps earlier, improving Star ratings and risk adjustment accuracy
• The platform supports Next Best Action—a data-driven recommendation for the most impactful clinical or administrative step a provider can take—at the point of care, guiding providers with real-time data

This proactive approach ensures that providers are equipped to close gaps before deadlines, reducing administrative burden and enhancing outcomes.

Program-based engagement at scale

Designed for payer-provider partnerships, it enables:

• ‍Program-based quality management with configurable measures‍
• Evidence collection and attestation workflows tailored to provider groups‍
• Omni-channel engagement via email, portals, and in-app messaging

This centralized approach ensures consistent engagement across diverse provider networks, driving measurable improvements in care delivery.

A value-based care platform built for outcomes

Reveleer’s focus on building one platform for value-based care is a pivotal shift in how provider engagement is executed. From AI-powered retrieval to proactive risk adjustment and seamless quality workflows to continuous engagement to incentivize providers, the platform is designed to deliver outcomes—not just data.

Whether you're a health plan administrator, a clinical leader, or a provider group manager, Reveleer’s solutions offer the tools and insights needed to engage smarter, act faster, and improve care.