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©2016 Availity, LLC | AV706-0816 RISK ADJUSTMENT: A Roadmap to Success AVAILITY WHITE PAPER AN AVAILITY E-BOOK
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Risk Adjustment: A Roadmap to Success

Jan 23, 2018

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Page 1: Risk Adjustment: A Roadmap to Success

©2016 Availity, LLC | AV706-0816

RISK ADJUSTMENT: A Roadmap to Success

AVAILITY WHITE PAPER

AN AVAILITY E-BOOK

Page 2: Risk Adjustment: A Roadmap to Success

QUANTITY

Quality over Quantity: New payment models are compensating health plans and providers for the quality of care they deliver rather than individual services.

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RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

QUALITY

Page 3: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK 3

This means new risk adjustment models MUST:

• Be more precise

• Include the direct costs of primary care services and the management of chronic conditions

• Include the indirect costs of care coordination.

Page 4: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

The need for more precise risk adjustment models means it’s more important than ever for accurate and timely data. But existing processes for managing this data don’t fit the bill.

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Page 6: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

Multiple departments within a health plan collect provider data for different purposes and store it separately.

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Page 7: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

Organizational silos are inefficient and disruptive to providers, who must field multiple requests—via phone call, fax, and in-office visits—from health plan employees looking for access to the same patient medical records. This is the Chart Chase.

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Page 8: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

Because providers are a critical source of patient information, health plans must have a way to capture data in a less intrusive way, or the quality of data will continue to suffer.

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Page 9: Risk Adjustment: A Roadmap to Success

RISK ADJUSTMENT: A ROADMAP FOR SUCCESS

AN AVAILITY E-BOOK

Health plans need a digital, scalable, enterprise-wide solution that:

• Works seamlessly over existing systems;

• Ensures data accuracy and eliminates inefficiencies; and

• Is able to pull components for HEDIS, STARS, and Care Management alongside risk adjustment and bundle them together.

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DIGITAL

SCALABLE

ENTERPRISE