Risk Adjustment Spotlight: Evolving strategies to drive risk adjustment performance

If you think the risk adjustment chart review process is frustratingly fragmented, you are not alone. Integrating in-house efforts with outsourced point solutions are often not only frustrating; they are also costly in terms of time and money. Increasingly, health plans are turning to Software as a Service (SaaS) as a way create an more strategic approach that helps enhance risk adjustment review performance.

What does a successful strategy look like?
One key way to overcome fragmentation is to integrate all aspects of your review process on a single platform. It’s also essential to be able to monitor that platform through the power of a dashboard that delivers line of sight into every aspect of the chart review—internally and with outsourcing partners.

What does it take to create an integrated system like this?
Building a SaaS solution internally can be challenging and cost prohibitive. These challenges go beyond developing and maintaining the technology to keep the system running.  It’s also important that your outsourcing partners can see and share data in real time to serve as effective extensions of your team. This is where point solutions don’t go far enough to seamlessly contribute to the cumulative knowledge needed to yield the most from each chart review.

What are hallmarks of an effective retrospective risk adjustment review platform?

  • Scope: Is the technology integrated with other risk adjustment services? The more services available through the platform, the more efficient and effective the overall outcome.
  • Scalability: Can the vendor support the elastic seasonality of risk adjustment with overflow resources? You should be able to count the vendor for all the on-demand labor you need.
  • Confidence: How likely is the vendor to be a viable partner over the long term? If you want to sleep well, make sure you select a partner that you expect to be at your side far into the future.
  • Reputation: Does the vendor have a history of meeting commitments? To avoid added frustration, you need a proven performer that cares about your objectives and deadlines as much as you do.

When is the best time to implement a platform strategy?
Given that a strategy can be in place in as few as three to four months, now is an ideal time to make a plan to be ready for the upcoming risk adjustment season.

Learn more with these resources:

  • Request a demonstration of the platform.
  • How integrated is your risk adjustment review strategy to help maximize performance? Connect with Optum to talk with an expert.


About the Author:

eli wolter headshotEli Wolter, Strategic Product Director at Optum

Eli currently leads product and technology strategy for retrospective risk adjustment at Optum, where he is focused on delivering innovation and value to clients through comprehensive, fully integrated retrospective risk adjustment programs. He has 16 years in information technology, much of that time with a health care focus. Eli has previously held roles in management information systems, health care process automation, software development, project management, solution delivery and product strategy.




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