ACA Payers




Affordable Care Act (ACA), focuses on patient outcomes, creating the need to eliminate unnecessary or duplicate services, and encourages the proper management of chronic disease to cut down or eliminate hospital visits and overutilization. To effectively manage the ACA patient’s population the engagement between physician and patient becomes essential. Ensure Data Solutions supports coordination of care, patient engagement and visibility to properly manage chronic patients and prevent further unnecessary utilization. It keeps its population controlled by allowing its users access to meaningful and actionable information.

How Ensure can help:

  • HEDIS predictive model that allows organizations to close care gaps and improve quality scores.
  • AI powered inpatient admission and readmission risk stratification.
  • Risk Adjustment model computations to assess exposure with risk corridors reconciliations.
  • Ability to create actions/tasks based on algorithms and analytics for clinicians to take actions.
  • Financial performance analysis against peers in the same geographic area (market-user defined), to better understand shared savings.
  • Control patient visits outside premium networks by identifying referral patterns.
  • Assign cost efficiency rating based on data collected and episode of care algorithm.

Why Ensure Data Solutions


Help predict and close care gaps, improve their CAHPS/HOS survey scores, and manage patient safety measures promptly with real time data.


Provide EHR integrations and FHIR interoperability to assertively collaborate on care gaps and other critical clinical information with other providers. Develop and deploy care treatments that enable the highest quality of care and improve outcomes.


Compile the necessary data to identify capitation network leakages. Visualize and compare specialists’ cost efficiency performance.  Evaluate referrals issued by organization. Help with identification of highly performing specialists to develop premium networks.


Enable clients to analyze patients’ reported clinical conditions and Dx codes. Create visibility into EHRs and HHS records to improve accurate and complete reporting, detect the need for better supporting documentation or to alert a provider when an action is needed.


Real-time admission/discharge/transfer alerts. Admission risk stratification powered by Artificial Intelligence. Complete reports to analyze financial impact and trends.