Health Fidelity

Comprehensive, scalable risk adjustment transformation solutions


Improving Outcomes

Comprehensive, scalable risk adjustment transformation solutions

Health Fidelity develops innovative technologies for health plans in the value-based health care era. The company worked with UPMC to develop a comprehensive risk-adjustment solution for Medicare Advantage, Medicare ACO, and health insurance exchange programs. The technology – first deployed at UPMC Health Plan – uses analytics, workflow optimization and point-of-care integration to provide the control, transparency and information necessary to successfully run risk-adjustment programs at health plans.

About Health Fidelity:

  • Natural Language Processing platform for risk adjustment at health plans
  • Founded 2011
  • Headquarters: San Mateo, Ca.


  • Health Fidelity has worked with UPMC Health Plan since 2014
  • UPMC Enterprises became a strategic investor in March 2015
  • Achieved 3x increase in coder productivity with Health Fidelity
  • Found $475 in additional risk-adjusted revenue per Medicare Advantage member per year
  • UPMC Health Plan continues to scale Health Fidelity

Case study:
Health Fidelity and UPMC Health Plan

  • Scout helped UPMC Health Plan discover new risk insights, increase revenue, and improve coder efficiency for its MA and ACA member populations.