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RISK ADJUSTMENT

RISE Webinar: Uniting risk adjustment, HEDIS, and Star Ratings initiatives

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
  • Focused on operations
  • Built on integrated processes
  • Improves efficiency and eliminates redundancies
  • Goal: Cost savings and improved performance
  • Personalized
  • Built on shared clinical insights
  • Optimizes every interaction
  • Goal: Improve member experience and outcomes
  • Unified solutions that provide a line of sight to plans and providers that enables delivery of the "right care"
  • Create a virtuous cycle driven by meaningful interactions
  • Coordinated care delivery to improve the member experience

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

Watch the on-demand webinar

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

WRITTEN BY

Jonas Foit
As senior vice president of analytics and reporting, Jonas supports Cotiviti’s Risk Adjustment, Quality, Network, and Consumer Engagement solutions with extensive healthcare analytics expertise and leadership acumen. Joining Cotiviti most recently from Molina Healthcare, where he served as vice president of risk adjustment, he is an experienced leader who has spent more than 15 years developing, managing, and executing analytics and operational programs for health plans and leading healthcare technology vendors.

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