In this case study, you will learn how a large Regional Health Insurer saw marked success on Risk Adjustment including:
• Closing appropriate risk adjustment gaps
• Receiving feedback from clinicians on conditions member does not have
• Achieving more accurate and complete risk scores
• Deploying the right intervention, with the right provider, at the right time
Successful risk adjustment plays a critical role in health plans’ operations. It helps ensure their beneficiaries’ health conditions and demographics are accurately documented. In doing so, it helps ensure that the health plan responsible for those beneficiaries is appropriately compensated for their coverage.
However, these are not the only roles of risk adjustment. Risk adjustment is also a critical tool for identifying potential gaps in care among beneficiaries. It enables payers to help ensure their beneficiaries develop high-quality connections with providers, allowing providers to document and promote patients’ health and care. These connections help ensure providers proactively manage patients’ health and that members receive the care they need. Research that engaged members are less costly and experience better health outcomes than non-engaged members.
Payers face numerous challenges navigating the risk adjustment landscape. Download this case study now to learn how a large Regional Health Insurer overcame numerous challenges to measurably strengthen their Risk Adjustment program.
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