Risk Adjustment Solutions: Taking A Different Approach

July 1, 2019 Jeanette Stern

Many organizations view risk adjustment as something that is a must-have, yet they do not view it as something that could be a major strategic asset. When you have the right alignment in place, risk adjustment can provide you with an incredible advantage in this competitive landscape.

Precise risk adjustment will not only provide you with the improvements you need when it comes to financial accuracy, but it will also provide you with the insight you need on population health. Health plans that are able to effectively and efficiently risk adjust at a decreased cost may also be able to lower premiums or rates. When these costs are lowered, it will generally result in a greater advantage in the market. 

Capturing Risks

Many health plans will think about potential and retroactive risk adjustment as two independent capabilities that will have their own financial plan and performance metrics. What if these things were viewed comprehensively? When these two types of risk adjustment are viewed comprehensively, all of the current and future efforts will need to be correlated. Health plans should perform retroactive reviews in order to properly follow up on the members who may have conditions that were not confirmed. There should be no medical condition that slips through the cracks. Risk adjustment should be approached in a way that is more member-centric.

Organizational Alignment

There are many collaborations that a health plan can successfully obtain involving risk adjustment. Plans will need to properly align resources so that everything can be influenced across every department. Also, a health plan's priority for retrieving charts should always think about every area of need so the tools and resources can be used to improve the organization as a whole. Member engagement, physician engagement, and patient assessments will also have the opportunity to be correlated across all capabilities.

Going Against The Norm

Risk adjustment continues to be a positional domain of healthcare plans. However, this will require a significant amount of knowledge of all the various processes and requirements. Consequently, there has not been a great number of changes to the way risk adjustment is completed. Many of the available vendor or provider services have been rendered because many plans are viewing them as something that can fulfill the needed processes without having a full strategy. Advancements in technology are making it possible to make the needed improvements to the risk adjustment process. As health plans begin to advance their risk adjustment strategies beyond the norm, the latest and greatest technology can be used.

Risk adjustment process continues to be an essential business process, and it is important to have a risk adjustment strategy that is comprehensive. There needs to be effective and efficient management of data when it comes to risk adjustment. Plans should continue to be assiduous when it comes to managing the overall quality of data and ensure agreements are congruent to improve accuracy while reducing the differences in data. It is also important that health plans are able to educate all stakeholders about any changes and the changing dependency on data. 

What type of approach are you currently taking to risk adjustment? When you take an organized and comprehensive approach to risk adjustments, health plans can gradually improve the overall performance that will have an impact financially and in terms of quality. Plans that make the decision to accept this approach and make the necessary adjustments will surpass their competition. 

Accurate risk can increase the quality of patient outcomes and reduce the need for an increase in premiums. For more information on risk adjustment solutions, please do not hesitate to contact us today.

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