Outside records, outsized impact — how unified data drives reimbursement.
Overview
VivaMas, a primary care organization with a Medicare Advantage focus based in Miami, Florida, partnered with Connective Health to solve a longstanding challenge in value-based care: surfacing likely missing chronic conditions, backed by internal and external records, in a way clinicians could actually use.
The Challenge
The average Medicare patient sees multiple providers — hospitals, specialists, pharmacies, and labs — and each encounter generates records that often live in silos primary care teams never access. For risk adjustment, that fragmentation is costly: every diagnosis needs clinical evidence, and when that evidence sits in outside records that haven't been retrieved, the diagnosis goes undocumented and the organization absorbs costs without corresponding reimbursement. VivaMas had tried other clinical documentation tools before, but each fell short on the same two fronts: clunky workflows and an inability to surface supporting documentation from outside records.
The Solution
Connective Health automated the retrieval of patient records from peer-to-peer EHR networks and national data sources, then distilled them into chronic condition insights embedded directly in VivaMas's existing workflow. Every suggested diagnosis arrives with the supporting documentation to validate it — spanning dozens of medical specialties and record types, including pharmacy fill data.
The Results
The impact was immediate and measurable. Physicians accepted 84% of suggested diagnoses, reflecting both the quality of the insights and the trust clinicians placed in them. 1 in 10 VivaMas patients had a new, valid chronic diagnosis code added to their chart, each backed by evidence that hadn't previously been available. Between increased risk adjustment revenue and reduced manual work, VivaMas achieved a 16:1 return on investment.