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 performance profiles, prioritised signals and intelligence that supports crucial healthcare decisions and growth, improves governance and reduces commercial, regulatory, litigation and reputational risk.

Our 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.

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

Our clients are often surprised by what can be done with the data they have, and often it is better than they thought. First, we assess your data, volume and completeness and analyse from there. Next, we can support you with a data transformation programme to help you progress to a richer dataset over time and receive more insights. 

Most tools show only part of the picture. QALYfAI® brings together information about care, patient experience, performance, cost and risk. It then highlights what matters most, helping organisations make better decisions and track progress over time.

The best place to start is with a confidential no obligation discussion with HVA’s engagement team. From there, HVA works with you to identify your key objectives, assess your data readiness and progress to delivery of insights based on the available data and comparable data HVA has access to. 

Outputs are tailored to your needs and may include dashboards, performance profiles, alerts, comparisons, recommendations and monitoring reports. They are usually updated monthly or quarterly, with important changes and emerging risks flagged through your insights portal.

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.

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 your data and analytical burden, not create another project. HVA manages the data and analytical work for you, freeing your teams up to focus on other priorities.  

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® gives payers clear evidence on outcomes, cost, performance and long-term risk. This supports informed discussions about pricing, service standards, improvement priorities and contract terms during negotiation, review and renewal.

QALYfAI® first defines the right patient population, then adjusts for differences in case mix and other relevant factors. This enables genuinely like-for-like comparisons, so providers are not unfairly penalised for caring for more complex patients.

QALYfAI® helps organisations decide what evidence to request, compare providers fairly, assess the quality of their data and identify important gaps. It can also establish a clear performance baseline for selection, onboarding, contracting and ongoing review. QALYfAI® supports the decision but does not certify providers or replace the organisation’s own due diligence.

QALYfAI® can connect claims, billing, consultant activity, provider activity and patient reported data to identify patterns of practice that are optimal or those that indicate risk. This can inform prevention, education, member support and proportionate risk review. NB: QALYfAI® does not predict individual claims or make underwriting, cover or claims decisions.

QALYfAI® includes FWA and claims integrity analysis, but does not treat claims as the whole picture. It connects claims signals with clinical, patient, population, provider, contractual and outcomes evidence to determine what is genuinely harmful, wasteful or poor value.

An unusual or high-cost claim, or a departure from the expected care pathway, is a signal - not a conclusion. It may indicate fraud or waste, but it may also be fully justified by the patient’s needs or the provider’s case mix. Without context, organisations risk challenging appropriate care, missing genuine problems or acting unnecessarily. QALYfAI® tests each signal against case mix, pathways, outcomes and expert review before recommending action.

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.