Case Study: PFFS Health Plan achieves 58:1 ROI and increased risk scores in less than 90 days with SCIO Health Analytics' SCIORevMaxPro

PFFS Health Plan Provider - Customer Case Study

PFFS Health Plan Provider, a Medicare Advantage plan with a private fee‑for‑service contract covering 20,000 members, needed a fast year‑end solution to identify which members had specific chronic conditions and which physicians should be targeted for outreach. With limited IT bandwidth, no software to generate targeted lists, and no internal outreach process, the plan engaged SCIO Health Analytics and its SCIORevMaxPro SaaS to help identify and manage intervention activity.

SCIO Health Analytics used SCIORevMaxPro to create near‑real‑time outreach lists and managed a multi‑pronged provider engagement campaign (initial contacts, mailed packets, follow‑ups) plus an administrative fee incentive for timely documentation. The effort increased documented risk scores, produced audit‑ready documentation, allowed the PFFS Health Plan Provider to retain additional revenue under the PFFS contract, and achieved a calculated ROI of 58:1 in less than 90 days.