To eliminate silos in their organization and create a more holistic approach to accurate risk adjustment, HEDIS® scores, and Star Ratings, many health plans have embarked on significant efforts to bring together their risk adjustment and quality improvement departments. A traditional approach unites these functions at a program level to create efficiencies and cost savings. Layering on a member-level approach built on shared clinical insights that incorporates consumer engagement can improve member experience and outcomes. Ultimately, an increased emphasis on informed decisions at the member level can deliver superior results that are more closely aligned with a health plan's overall goals.
|Program-level approach||Member-level approach||Health plan goals|
I hope you’ll join me and my Cotiviti colleague Melissa Silva, vice president of product management for risk adjustment, quality, and analytics, for an on-demand RISE webinar. We’ll discuss the “next best action” analytics approach at the member level with the potential to deliver tangible impact for both risk adjustment and quality improvement. Learn how to better the outcome for patients, providers, and you.
On-demand webinar viewers will gain a better understanding of:
- Aligning risk adjustment and quality improvement at a member level
- Combining datasets across functional areas to surface insights on revenue gaps and gaps in care
- Incorporating consumer engagement to drive outreach to members and providers
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).