Leveraging natural language processing to manage risk

Practice Management

As the healthcare industry continues on its transformative path to value-based care, organizations are tasked with ramping up their data analytics capabilities, especially around understanding the risk of their member population.

San Mateo, Calif.-based Health Fidelity strives to support providers and payers by extracting insights from medical charts, changing the way clinical and financial risk is identified, assessed and managed.


The 2011 startup created a natural language processing and machine-learning technology platform in collaboration with New York City-based Columbia University, due to the institution's storied history with clinical NLP.


"Our whole premise around NLP is leveraging the technology to help risk-bearing entities better manage the population risk of their covered lives," explains Steve Whitehurst, CEO of Health Fidelity. "We're giving providers and payers a clearer picture [of the patient]."


By collaborating with Columbia University, Mr. Whitehurst notes Health Fidelity's NLP "inherited a lot of breadth and depth of clinical expertise."


The company uses NLP to extract insights from unstructured data in medical records (i.e., clinical narratives) and combines it with structured data from other sources. This process offers a more comprehensive view of the patient, providing additional insights about each patient's health status and potential care gaps.


Health Fidelity's platform leverages machine learning to constantly improve its algorithms for pinpointing missing risk factors.


"A lot of times, we are hired to help find additional risk factors in members, but we also support finding instances of over-identified risk factors, which can be a compliance hazard," says Mr. Whitehurst.


The startup's NLP-assisted risk adjustment platform stands out due to its ability to increase the accuracy and productivity of coders. By enabling NLP to first scan through the documents for evidence of Hierarchical Condition Categories opportunities, coders can find HCCs that are often missed in manual reviews.


Health Fidelity's risk-adjustment solutions are available for organizations participating in Medicare Advantage, ACA, Medicaid and Medicare ACO programs.


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