Where are you going? And how quickly are you getting there?Â
The risk adjustment model is evolving rapidly because of RADV, EDPS, and your health plan competitors.
Health plans and medical groups are moving from a chart review model to the premier member knowledge & engagement model.Â Your transformation should look like this if you have PFFS, PPO, or HMO products:
â€˘Â Early Model: 1.7 charts reviewed per member with no member evaluations
â€˘Â Next Model: 0.65 charts reviewed per member with 5-15% member evaluations targeting
â€˘Â Goal Model: 0.30 charts reviewed per member with 60-85% member evaluations targeting
â€˘Â SNP Goal Model: 0.50 charts reviewed per member with 100% member evaluation targeting (we will blog more about SNPs soon, due to their unique nature)Â
This not only offers you more timely andÂ accurate revenue but, more importantly, member information for a comprehensive plan of treatment which should reduce gaps in care and highlight care management needs forÂ the patient population.Â
If you have questions or need to remodel your strategic plan or budget, we have a client roadmap module to transition your risk adjustment program without impacting accurate revenue or blowing your budget.