Category Archives: by Sam Diederich

Best practices for Medicaid risk adjustment accuracy

Applying risk adjustment best practices to the ever-changing landscape of managed Medicaid risk adjustment For those providing health care in managed Medicaid markets, there are many challenges such as: Risk adjustment models and timing vary from state to state. This makes it hard for managed care organizations (MCO) managing multiple plans to run a risk […]
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Outcomes management helps ensure optimal care to members

To improve member outcomes and enhance the quality of care, provider groups and practices need useful feedback. A flexible model backed by real-time and actionable reporting provides such feedback. Understanding the program objectives and managing to specific outcomes is vital to improving quality and risk adjustment performance. Payers set outcomes goals, and an outcomes manager […]
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The Power of Three: A New Model for Quality and Risk Adjustment Provider Engagement

Experienced quality and risk adjustment experts help improve member outcomes By Sam Diederich, Vice President of Strategy and Business Integration, Optum When payers manage quality and risk adjustment for government-sponsored membership, it creates a significant burden for care providers. Consider the situation from the provider’s point of view. Each payer sends data and asks for information […]
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Aligning risk adjustment and quality management

Many health plans maintain separate risk adjustment and quality management programs, with purposefully siloed objectives and metrics. But aligning the two enables true transparency from data to analytics, and provides numerous benefits: Revenue growth Improved outcomes Reduced medical spend Managing at-risk populations requires health plans to have the appropriate controls and processes in place that […]
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Five best collaboration strategies to improve HEDIS rates

There are many ways to measurably improve HEDIS rates and the quality of care of members. The true challenge is navigating the various barriers that can delay your journey to get there. Without a doubt, collaboration is the difference between higher and lower HEDIS rates. The more effective the collaboration — and integration — the […]
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