FAQs

QALYfAI® is HVA’s Healthcare Performance Intelligence platform. It uses AI, supported by expert review, to connect fragmented healthcare evidence and convert it into comparable performance profiles, prioritised signals and intelligence that supports decisions.

Clients combine the QALYfAI® platform with HVA’s clinical, analytical and commercial expertise. The engagement is designed around an agreed decision or performance question and can extend into wider comparison and ongoing monitoring where appropriate.

The primary audiences are healthcare payers, providers and indemnifiers. QALYfAI® can also support administrators, procurers, innovators, policymakers and organisations that provide analytical or technology services. The evidence, outputs and decisions are agreed for each use case.

HVA begins by defining the decision, population and evidence scope. We agree a proportionate route for data access, assess the evidence available, make limitations visible and create an initial performance baseline before wider monitoring or action is agreed.

A use case can begin with the evidence available. HVA maps current data and reporting, identifies material gaps and makes limitations visible. Further evidence or validation is added where it is needed to support a fair and proportionate conclusion.

Depending on the use case, evidence may include clinical, claims, authorisation, billing, provider, pathway, financial and contractual data, together with outcomes, patient reported experience and risk evidence. No single organisation needs to hold every data type.

No. A consistent framework supports comparability, but definitions, benchmarks, thresholds, risk adjustment and outputs are agreed for each use case. Expert review considers patient need, case mix, pathway design, data quality and other relevant context.

Many tools analyse one source or one part of the performance question. QALYfAI® connects clinical, patient, operational, commercial and risk evidence within one contextual model, combining fair comparison with expert review. It turns that wider view into prioritised intelligence for selection, contracting, management, improvement and renewal, with ongoing monitoring designed to fit existing workflows.

Not necessarily. Patient experience is important, but it does not alone establish clinical effectiveness, productivity or total cost. QALYfAI® considers experience alongside outcomes, case mix, utilisation, cost and risk.

Outputs are agreed upfront and tailored to the customer’s use case, teams and existing workflows. Depending on scope, they can include comparable performance profiles, prioritised alerts, provider, pathway or healthcare solution comparisons, dashboards, review packs, monitoring reports and concise decision briefs.

Findings are prioritised by materiality and confidence, supported by context and presented with proportionate options. HVA helps teams determine whether to validate, investigate, engage a provider, review a pathway or contract, recover inappropriate payment where relevant, or continue monitoring. The customer owns the decision and action.

QALYfAI® can identify potentially avoidable activity and connect it with provider, pathway, case mix, outcomes and contractual context. This helps teams distinguish a transaction issue from a wider performance issue and act on the underlying cause.

No. QALYfAI® is designed to reduce the analytical burden, not create another project. We agree the use case, outputs, owners, review cadence and escalation routes at the outset. HVA manages the data and analytical work, then delivers prioritised dashboards, alerts, review packs or decision briefs that slot into existing clinical, provider, commercial and governance processes.

Once the scope and data flows are agreed, QALYfAI® can monitor performance at the agreed cadence and proactively flag material change or emerging risk.

QALYfAI® can move reporting beyond activity and spend to evidence of network performance, outcomes, experience and total pathway cost. This helps funders and administrators explain what their proposition delivers, where it is improving and how emerging issues are being managed. It can support stronger renewal and retention conversations.

QALYfAI® provides comparative and longitudinal evidence beyond unit price, including outcomes, experience, productivity, total cost, variation and contractual performance. It can support baseline setting, negotiation, ongoing reviews, improvement tracking and renewal or reconfiguration informed by evidence.

Comparison is agreed for the use case and can include risk adjustment, patient need, case mix, longitudinal context and expert review. QALYfAI® identifies strong performance as well as material variation, and findings can be reviewed with the provider before action is considered.

QALYfAI® can connect consultant, provider, pathway and patterns of practice with outcomes and other performance evidence. This can inform prevention, education, member support and proportionate risk review. It does not predict individual claims or make underwriting, cover or claims decisions.

Yes. HVA can help define evidence requirements, compare available performance evidence, assess data readiness, identify material gaps and establish a baseline for tender, onboarding, contracting and review. QALYfAI® does not certify a provider. The appointing organisation retains due diligence and selection responsibility.

QALYfAI® can support agreed performance measures, thresholds and review triggers. These can inform progressive contract management using evidence, while contractual decisions and changes remain with the parties.

No. Fraud, waste and abuse analysis and claims integrity systems remain important for transaction and payment integrity. QALYfAI® can incorporate their signals and connect them with wider clinical, patient, operational, contractual and risk evidence.

Unit price is only one part of total performance. Poor pathway design, avoidable variation, rework, complications and weak outcomes can create downstream cost. QALYfAI® connects spend with process and outcomes to help organisations understand what is driving cost.

No. It works alongside existing administration, claims, clinical, financial, analytical and governance environments.

QALYfAI® combines data quality and statistical checks, appropriate risk adjustment, longitudinal analysis and benchmarking with expert clinical and analytical review. Material findings are interpreted in context, with assumptions and limitations made visible.

Customers retain data ownership, governance, due diligence and decision authority. HVA provides performance intelligence and expert interpretation. It does not make customer decisions.

For regulated firms, QALYfAI® can support regular outcomes monitoring by connecting relevant evidence, highlighting potentially poor outcomes and tracking investigation and action. It does not itself establish compliance. Firms retain regulatory responsibility.