Advalent’s Risk Adjustment solutions are designed to deliver significant ROI to healthcare organizations while enabling stronger provider relations through proven-collaboration models.
Risk Adjustment has been increasing in complexity from the regulatory and operational perspectives considering the dynamic compliance/audit requirements and the risk scoring methodologies. In addition, as payers move from fee-for-service to pay-for-performance models with providers, a very important question to address is – how to account for Risk Adjustment in the whole journey toward ‘value-based care’. From identifying suspect (undiagnosed, uncoded, miscoded and undercoded) cases to driving the diagnosis (or HCC/DC) gap closure operations through the right interventions and completing the data submissions to CMS, we help health plans improve their financial performance while complying with all the regulatory requirements. Our analytics identify probable HCCs that have gone undocumented to drive revenue enhancement through clinical interventions – Medical Record Retrieval, Provider Education and Encounter Facilitation (Office Visits or Home Health Assessments). Our analytic approach is designed to include overlooked chronic conditions, worsening disease state and unconfirmed diagnosis, labs, prescription fills among various other clinical/utilization markers to assess the complete member condition. Our Risk Adjustment solution is EMR ready – with our proprietary EMR-Connectors – to automatically extract the targeted DOS from EMR systems to drive Risk Score improvement on a near real-time basis.