In this paper, Health Fidelity outlines the concept of a 360-Degree View of Risk Adjustment and articulates why it’s vital to succeed in today’s value-driven care environment. Additionally, organization’s can also learn the evaluation framework required to assess your readiness to adopt the 360-Degree View.
In order to make downstream risk adjustment modernization efforts as effective as possible, organizations need to ensure they have the appropriate structure, goals, and incentives in place. In this next chapter, Health Fidelity examines the operational infrastructure and leadership activities required to set a foundation for performance improvements.
Providers are key partners for many payer-led initiatives, including but not limited to risk adjustment. In order to enhance both quality of care and financial outcomes, organizations should make sure the appropriate alignment, incentives, education, and tools are in place to increase providers’ engagement with these initiatives.
Organizations should enable access to the fullest breadth of up-to-date clinical data from medical records. Many areas within the organization will benefit from increased access to data – not just risk adjustment. The key is to invest in scalable solutions that enable multiple departments to leverage a common set of records and reduce redundant chart retrievals that are extremely costly.
Today, the use of technology to generate analytics and direct operational resources is the minimum automation required for payers to compete in a world of increasing data, growing memberships, and intricate provider networks. Hear how Chinese Community Health Plan (CCHP) has leveraged technology over the past two years to improve their risk adjustment performance.
Health plans and providers in risk-sharing arrangements are equally responsible for risk adjustment and quality outcomes, and not just at the integrated delivery system level. To be successful, they must build a strong working relationship. Find out how UPMC achieved this collaboration and hear their results.
Medical record retrieval is commonly cited as a top pain point, but new data acquisition technology may change the way you feel. In this webinar, hear how you can leverage this innovation, and how other organizations have reduced their chart retrieval costs while improving their risk adjustment ROI.
With the mandate to “do more with less,” Providence Health Plan turned to Natural Language Processing (NLP) technology to address their risk adjustment challenges. In October, Providence Director of Coding Compliance – Rebecca Welling – shared how her decision to equip her coding team with access to all available information via NLP allowed for better efficiency, increased risk capture, and reduced audit risk.
In 2014, UPMC Health Plan, as part of a leadership-sponsored strategic initiative, implemented Lumanent Retrospective Review to help increase accurate RAF capture in compliance with CMS Risk Adjustment guidelines while improving overall coding efficiency. The health plan, which was already running sophisticated risk adjustment operations, saw a remarkable return on investment with a study conducted on PY2012 members.
Papers & Reports
A key focus area required for value-based care success is setting up a comprehensive risk capture strategy, in which organizations need to accurately identify, document, and report the known risk conditions of each patient in order to receive commensurate reimbursements. Discover how organizations like Mount Sinai Health Partners who use a risk capture maturity model to plan out their improvement path forward are seeing better outcomes in this white paper.