Intus Care Announces Launch of IRIS, the Next-Generation of PACE and Value-Based Care Risk Adjustment

The Real-Time, Data-Driven System Is Designed for Programs of All-Inclusive Care for the Elderly (PACE) and Value-Based Care to Drive Consistent Risk Adjustment Results

July 10, 2024, Providence, RI – Intus Care, a pioneer in advanced software and data-driven solutions for geriatric healthcare, today announced the launch of the Intus Revenue Integrity System (IRIS), the first real-time, data-driven risk adjustment system designed specifically for PACE (Programs of All-inclusive Care for the Elderly) and value-based care (VBC) organizations. Intus Care currently supports over 60 PACE organizations through its software platform and services.

IRIS is designed to support PACE and VBC clinical, financial, compliance, and leadership teams to optimize workflows for consistent risk adjustment results. The system provides coding and validation for compliant workflows, real-time analytics to trigger the next best action for HCC capture and recapture, and targeted audits and education to drive performance improvement.

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Coding Validation

IRIS’s team of certified coders uses natural language processing (NLP) to find diagnoses that map to hierarchal condition categories (HCC) or RxHCCs, saving time and workload for providers on documentation. The coding files are supplied in an Encounter Data Reporting System (EDPS) ready format, ensuring the organization is ready to submit in accordance with the new reporting system, required by the start of 2025.

The real-time query process, initiated by certified coders, allows care teams to clarify HCCs and identify high-risk conditions for a complete clinical picture, with the risk-adjusted diagnoses validated before submission to the Centers for Medicare and Medicaid (CMS).  

Real-Time Analytics

With real-time analytics, IRIS gives providers up-to-date data so they can focus on the next best action for optimal risk adjustment and improved health outcomes for participants. The software reports out missed opportunities (MOpp) to ease HCC recapture.

For revenue integrity, the real-time analytics provide a full view of the monthly membership report (MMR), with up-to-date enrollments, disenrollments, and change transactions. IRIS surfaces discrepancies in over a dozen categories to optimize Medicare revenue and assist with payment reconciliation across initial, mid-year, and final estimates.

Targeted Compliance Audits and Training

Finally, IRIS supports data-driven, targeted compliance audits, surfaced from the analytics. The Intus Care team develops an action plan based on the audit to affect action on any deficiencies and, as needed, provides clinical training for improved performance. PACE and risk adjustment coaching is also available for new and seasoned clinical staff.

“Our customers leverage the Pop-Health platform for data-driven decisions and optimal participant care strategies,” said Robbie Felton, CEO of Intus Care. “We are excited to add IRIS as a tool to streamline the accurate documentation and capture of PACE risk adjustment, further supporting our current and future PACE partners.” 

The IRIS module can be integrated into the current Intus Care platform. Current customers who are interested in IRIS can contact Intus Care through the website or directly through the Intus Care platform to find out when integration may be available.  

About Intus Care

Intus Care empowers PACE organizations nationwide through automated software and PACE expert consulting. Our PACE-focused analytic platforms empower workflows across clinical decision-making data accessibility and risk adjustment, while our Integrated Care Service experts collaborate with programs to improve Compliance, Quality, Utilization, and more through a hands-on, data-driven approach.   

Intus Care currently works with over 60 PACE programs across 18 states and closed a $14.1M Series A in Q4 of 2022.    

Visit our website to learn more intuscare.com.