RaeAnn Grossman.

The Goat Rodeo

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You hear a lot of interesting comments when you are meeting with health plans and large medical groups. One of my favorite phrases is “last year was a goat rodeo.” The visual makes me laugh every time – goats, kids, and general goat chaos. However, in risk adjustment, you cannot afford an internal or vendor “goat rodeo.”

If last year you had a risk adjustment goat rodeo, start taking notes and you may want to ask for some strategic planning assistance.

Here are the quick start metrics you should collect, map out, and monitor:

• 2011 Chart Review Volume, ROI, and projected timing of premium impact
• 2012 Hospital Data Feed Schedule from their HIMS database
• 2011 Member assessment volume, ROI and projected timing of premium impact
         o Percent and impact by PCP
         o Percent and impact in the SNF setting
         o Percent  and impact in the in-home
• 2011 Member data link to member services, case management, and PCP
• 2012 Chart review and member evaluation findings strategies linking to care
• 2012 Gaps in care closure program (outreach to documentation verification)
• 2011 HEDIS deficiencies and resolution success
• 2012 HEDIS program roadmap
• 2011 STARs goals and impact
• 2012 STARs roadmap
• 2011 & 2012 Claims based HCC analysis and documentation closure initiative

If you have a roadmap with timelines and an internal project leader for these aforementioned tasks you may still headed for a goat rodeo. The final pieces to ensure success are internal controls, plus a strong, efficient, and effective partner.

RaeAnn Grossman.

About RaeAnn Grossman.

RaeAnn Grossman is one of the nation’s foremost experts on risk adjustment strategies and provider and payer alliance configurations, along with healthcare business and product development. She brings Gorman Health Group more than twenty years of professional experience in a wide variety of healthcare organizations including Health Plans, Medical Groups, Physician Hospital Organizations (PHOs), Integrated Hospital Systems, and Institute of Health Professionals Education. Read more

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