Tag Archives: risk adjustment

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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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 […]
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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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Are you there yet? Navigating the journey to integrated risk adjustment and quality programs for your health plan

Embarking on the quest to improve your risk and quality integration may seem daunting, with so many moving parts to consider. The challenge is to know where you’re going and how to get started. The journey to an effective risk-plus-quality strategy is easier to navigate when you employ best practices to increase provider engagement, create […]
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Evaluating effectiveness of your organization against best practices for risk adjustment and quality programs

Whether it’s to reduce medical loss ratios or improve competitive positioning with more affordable products, health plans are under increasing pressure to reduce medical expenses through population health management. Where do you start when it’s difficult to identify and prioritize areas of opportunity that will have the greatest impact? A critical first step is to […]
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Provider engagement has a major impact on quality, costs and outcomes

Health care market dynamics now impose risk adjustment and quality standards on financial performance across all market segments — Medicare Advantage, Managed Medicaid and commercial plans. To balance risks, improve quality and decrease costs, plans must move beyond retrospective claims analysis and basic assessments. Improving plan performance also hinges on provider engagement. A changing market […]
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