Health & Medical,

3 Ways to Modernize Risk Adjustment Solutions and Programs

The industry is slowly shifting toward value-based care and new payment types, it’s essential for health plans to continue to improve risk adjustment solutions and programs. Modernizing solutions and operations present some unique challenges and things worth considering.

Data Acquisition and Analytics

Are you using all the possible forms of data for your risk analysis? Start your health plans by looking at the types of data available. New technologies help provide new ways to acquire and analyze data. In most cases, this includes administrative data, such as medical, pharmacy and laboratory claims. Approximately 80 percent of the data lies in other forms, such as clinical charts and plans. These records are more likely to include ROI-influencing risk conditions.

The Need for Automation

Manual methods of calculating retrospective risk adjustment solutions and programs just can’t keep up with today’s pace. Growing membership in new value-based systems requires up-to-date tools to streamline the process. Automation also reduces human error and the risk of audits. Many manual processes can easily be automated without additional staffing.

Incentives for Providers

Providers are a key part of risk adjustment solutions and programs and must follow best practices for calculating risks. Providers across networks have differences in coding accuracy on claims, the way they share patient data, membership profiles and many other factors. Health plans need to be equipped with analytics to appropriately gauge provider performance and then create incentives to encourage improvements.

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