Rushikesh Mali

CORE Analytics

CORE ("Claim Outcomes & Reimbursement Essentials") applies proprietary Intellectual Property to current SNF-specific and accretive peer-group data to produce meaningful & actionable insights. The CORE UB-04 intelligence solution generates comparative analysis, risk management support and reimbursement optimization logic – specifically designed for SNF financial and reimbursement professionals. The Partners of Zimmet Healthcare, the SNF industry's leading consulting firm servicing over 2,500 providers & stakeholders nationwide, developed CORE after realizing the limitations of publicly available claims data prevalent in the marketplace. We understood the need to quantify the qualitative elements of post-acute "value" and realized that a scalable digital solution was required, and that such a system must be predicated on recent claims data (and not year-old data). After contacting dozens of analytics providers in the market we quickly realized that while every system had its benefits, not one delivered anything close to the level of intelligence SNFs require in the highly competitive environment for short-term admissions and emerging risk-based payment. The shift from RUGs to the Patient-Driven Payment Model (PDPM) has changed provider reimbursement from service utilization to patient characteristics, furthering the need for advanced predictive analytics in the market.