Caredatum Risk Assurance
A true and fair view of your risk position.
Caredatum is a risk assurance firm. We establish what your quality, risk, utilization and operational performance actually is, on evidence you can trace, and then we work the distance between that position and where it should be.
The position we take
An organization carrying risk should be able to state its own performance, support every part of that statement with the record behind it, and know what the number would be if the work were done.
Almost none of them can. Not because the data is missing, but because nobody has ever established it to a standard that would survive being questioned. That is the whole of what this firm does.
You are being graded on a number you did not calculate.
Your risk adjustment factor arrives from the plan. Your quality rates arrive months after the period they describe. Your utilization shows up in a settlement. By the time you can see your position, the year that produced it is closed.
The number is someone else's
The party that pays you also calculates what you earned. You have no independent basis on which to question it, and no way to know what was left on the table.
The evidence is not attached
A gap list tells you a member is open. It rarely tells you what closed it last year, what documentation would support it this year, or whether the claim that should have closed it ever posted.
Nothing is ever restated
Performance is reported as a snapshot and never reopened. Movement, which is the only thing anybody can actually manage, stays invisible.
The practice cannot absorb the work
Even a correct list of what needs doing is worthless if there is no appointment to do it in. Access and capacity decide whether any of the first three can be closed at all.
Not everyone we work with carries risk
Plenty of the practices we work with are paid fee-for-service, and the first three problems above are not theirs. The fourth one is. Whether a practice is running well, and what it would earn if it were, is the same question under either payment model, and it is answered with the same instrument.
Healthcare has an ERP. It has never had a CRM.
One member, one record, one owner.
The electronic health record runs the encounter. Claims run the transaction. Neither one holds the member across encounters, payors and years, which is exactly where performance is won and lost. We built the layer that does, because every position we take is only as good as the record underneath it.
A record of the member, not the encounter
Not a customer relationship system with healthcare labels applied to it. A system of that kind models a deal and the steps to close it. This models a person, their clinical and financial history across every payor, and the member of your staff accountable for what happens to them next.
What we assemble
Claims and eligibility from every payor you contract with, clinical and encounter data from the practice systems, pharmacy, and the operational data the practice produces every day: the schedule, the capacity, the referrals, the fill rate.
What it resolves to
One member, one identity, one continuous history, matched and deduplicated across sources that routinely disagree with each other, and aligned to the provider and contract actually accountable for them.
Why it decides everything downstream
A finding is worth exactly what the record behind it is worth. The member record is the working paper for every position we take, which is why we assemble it ourselves rather than reporting on whichever extract we are handed.
Truescore is how we establish the position.
One methodology, applied across four dimensions of performance. Every finding carries the record it came from, every position is restated on a cycle, and nothing is closed on the word of the person responsible for closing it.
Dimension 01
Quality
Which measures are open, what specifically closes each one, and what was done for that member last year.
Dimension 02
Risk
Which conditions the record supports, which it does not, and which are absent entirely, with the documentation each one would require.
Dimension 03
Utilization
Where care is happening that does not need to. Specialist prescribing, emergency department patterns, avoidable admissions, brand dispensed where a generic exists.
Dimension 04
Operations
Whether the practice can physically deliver the work the first three create. Access, scheduling, fill rate, panel capacity.
Why operations sits alongside the clinical three
Most of this market treats practice operations as a separate discipline from risk and quality. It is not. A panel with no available appointments cannot close a gap, and a provider at capacity cannot address a condition the record would support. Operations is the constraint the other three run into, so we score it in the same instrument rather than in a different report. It is also the dimension that matters whether or not you carry risk, which is why it does not sit inside the risk work alone.
Two practices on one record.
One assesses how a book of members is performing. The other assesses how a practice is running, and what it would be worth run properly. Both read from the same member record and both are scored with Truescore.
Practice 01
Caredatum Risk Assurance
The value-based care practice. Quality, condition accuracy and utilization across every contract you hold, scored alongside the operational metrics that decide whether any of it can actually be delivered. Those operational metrics matter whether or not you carry risk, so the practice serves a fee-for-service book as readily as a risk book.
- Condition accuracy, with the documentation each one requires
- Open quality measures, with what closes each one
- Utilization the panel is absorbing without benefit
- Scheduling, fill rate and panel capacity, for either book
- A one-page provider view, prepared before the visit
Practice 02
Caredatum Operational Assurance
The practice evaluation practice. What a practice earns, what it costs to run, how well it actually operates, and what it would earn if the fill rate rose or the scheduling were corrected. It needs no risk contract to be useful, which is why it is the work most of our fee-for-service clients start with.
- Is the practice profitable
- Is it running efficiently
- What it would earn with fill rate and scheduling corrected
- Evaluation before an acquisition, and operating assurance after one
One operational layer, surfaced twice
The scheduling, fill rate and capacity work is built once. Inside Risk Assurance it answers whether a panel can absorb the clinical work the other three dimensions identify. Inside Operational Assurance it answers whether a practice is worth acquiring, and what it would be worth run properly. Same measurements, two questions, and a client can buy either without buying the other.
A position is worth what the evidence behind it is worth.
Anyone can produce a number. What makes one worth acting on is whether it can be walked back to the record that produced it, and whether the closure behind it was verified rather than asserted. That is the whole of our method, and it is the thing to hold us to.
| Firm | What they see | What they produce | How closure is verified | Where operations sit |
|---|---|---|---|---|
| Enablement partners | The contract they enrolled you in | Performance on that contract | Their own reporting on their own contract | Outside the arrangement |
| Analytics vendors | Whichever data they were given | A reporting environment you staff | However your own team decides to | A separate product, where it exists at all |
| Caredatum | Every contract you hold, across all lines | An evidenced position, restated on a cycle | Confirmed in the source data, and reported against what was claimed | Scored in the same instrument as the clinical three |
None of this makes an enablement partner the wrong choice. Many of our clients are inside one and should be. It does mean that a view of one contract is not a view of the organization, and the two are easy to mistake for each other.
The three that come up every time.
Why not build this internally?
Some organizations should, and a few have. The question is not whether your team is capable of it. It is whether the thing they would build gets independently checked, restated on a cycle when the method changes, and defended by somebody whose name is on it. An internal build answers to the same people it reports on. That is the specific property an assurance engagement exists to remove, and it is not a staffing problem you can hire your way out of.
How long before this is useful?
The baseline runs on one period of data you already hold, and it is a deliverable rather than a milestone: you see your position before you commit to anything further. What we will not do is quote you an implementation date on this page. What is establishable depends on what your systems expose, we determine that before scoping rather than after, and you get told which measures we cannot produce and why.
Why does this cost what a practice costs, rather than what software costs?
Because the hardest part is not the computation. The same word means different things at different organizations, and definitional drift, one term quietly carrying two meanings, is the single largest source of wrong numbers we encounter. Resolving it takes a working session with your team rather than a configuration file. A software company has to apologize for that. An assurance practice bills for it, because it is the work.
Next step
Start with a baseline.
Give us one period of data from the contracts you already hold. We return your position across all four dimensions, the evidence behind every finding, and the specific work that would move it. You decide what happens after that, not before.