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Value-Based Care and Health Equity Post 2021
After more than a decade of debate, litigation, and experimentation, the adoption of value-based care and alternative payment models endures, and 2021 is presenting us with a picture of what more can be done with value-based care and health equity. First, beyond the headlines and political posturing, policymakers and market players have persevered through ongoing […]
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Concurrent EDPS and RAPS support from Lumanent
Health Fidelity is pleased to share that the Lumanent platform is fully prepared to offer concurrent EDPS and RAPS support, congruent with the CMS-HCC risk adjustment model transition.
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What is two-sided healthcare risk?
Depending on your role at a health plan or risk bearing health system, you’re aware of value-based care (VBC) models. However, depending on the model itself (and sometimes within the same model of value-based care), there can be different variations of two-sided healthcare risk, also known as upside and downside. An organization’s level of engagement […]
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2021: The Year of Optimized Risk Adjustment
Calling 2020 disruptive to healthcare is an understatement. But 2021 offers some unique opportunities to become a year of optimized risk adjustment. With the signing of the American Rescue Plan Act of 2021, barriers and premiums for COBRA have been reduced or eliminated, there are new Medicaid expansion incentives, and the ACA marketplace has an […]
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ACA Risk Adjustment: A Competitive Advantage
With the Biden administration re-opening the ACA exchange and the impacts of COVID-19 on employment through 2020 and beyond, we want to address the impact of ACA risk adjustment. The expanding healthcare landscape under the ACA and the continuous shift to value-based care means effective risk adjustment is often the difference between profitability and losses […]
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CMS Policy Update: RAPS and EDPS, Model Updates, and PY 2022 Risk Calculations
Last month, CMS released their final announcement for calendar year (CY) 2022. This is a follow up to the advanced notice we covered September, particularly around the RAPS and EDPS transition. Before we begin, I think it’s important to mention that while not every facet of every update from CMS impacts every organization the same […]
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The Opportunity and Benefits of the Clinical Review Specialist
A hallmark (and problem) of technology in healthcare has been the drive to automate processes and eliminate staff headcount to boost ROI. For risk adjustment operations in particular, this often results in an increased burden on physicians, asking them to learn and apply CPT, ICD-10, HCC, and any number of other codes alongside their primary […]
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What is Risk Adjustment in Healthcare?
Risk adjustment is a critical part of both the financial and clinical aspects of healthcare in the United States. Still, even many people working in healthcare don’t really understand what it is, why it’s important, or how it works. First, what is risk adjustment? Healthcare for approximately 110 million Americans is provided by the US […]
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CMS Policy Update on Encounter Data and Positive Risk Score Impact
On September 14th, CMS released part I of an advanced notice on risk adjustment for Medicare Advantage. The advanced notice itself has caused a stir despite being an update on the already in-progress transition toward the exclusive use of EDPS (encounter data processing system) for risk adjustment data submission, and the phasing out of RAPS […]
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An effective and essential risk adjustment strategy includes the prioritization of chronic condition recapture each year. The benefit of prioritizing your HCC recapture rate comes directly from the requirement of re-confirming a diagnosis and treating it. First, it ensures regular contact with clinicians to monitor and manage chronic conditions, overall improving the quality of care. […]
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ACO Benchmark Calculation: Successfully Understanding the two Levers of Cost and Risk
Our latest ebook, Pulling Both Levers: A Four-Year Analysis of Medicare Cost and Risk Adjustment, unpacks the critical, and often overlooked, importance of effective risk adjustment done in conjunction with medical expense reduction under value-based care.
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Flattening the Other Curve: Using Risk Adjustment to Manage Rebounding Patient Volumes
As care patterns continue to shift, and we see new utilization patterns, the stability of capitation and the revenue insulation provided by thorough, effective risk adjustment are key to thriving during uncertain times.
Tag: Value-Based Care
Risk Adjustment’s Role in Value-Based Care
The transition from fee-for-service to value-based care is not only changing how patients are cared for, but also how providers are measured and compensated for performance, and risk adjustment is a key component to the financial success of risk-sharing arrangements.