George Platt, MSOM, PAHM
Chief Executive Officer and President
Health Plans Rely On Affinitē Risk™ for Risk Adjustment Efficiency
Designed by risk experts, Affinitē Risk provides high-value insights into member-specific gaps, risk scores and provider performance.
Managing risk for your plan’s members can be challenging. For starters, updates to the risk models require periodic changes to your plan’s method for calculating risk. If these are not addressed, your plan may be improperly submitting data, which could negatively impact your risk score.
Another factor is the complexity of properly coding claims to accurately reflect the acuity of an individual member’s health during the year. Providers sometimes make mistakes when coding conditions – which may lead to a lower Risk Adjustment Factor (RAF). Also consider that your staff might, albeit unknowingly, spend too much time closing low priority gaps. This inefficiency may also negatively impact your plan's overall risk score.
Vital Data Technology’s Affinitē Risk module solves these challenges by providing a cloud-based solution capable of instantly performing real-time identification and prioritization of model gaps for investigation – directly aligned with your plan’s highest priority conditions. Furthermore, risk teams have deep-dive capabilities to see member-specific medical records streamlining their medical record review and abstraction process. Affinitē Risk also formats the documentation in the prescribed format for submission. The result; greater positive impact on your plan’s Risk Adjustment Factor.
Key Ways Affinitē Risk Helps You Maximize Risk Adjustment
Compute risk scores and opportunities daily at the member and provider level for either Medicare or Exchange populations on a 12-month rolling cycle
Achieve higher RAF for specific categories by focusing on those with the highest potential for improvement
Provide health plan staff with real-time, forensic analysis of risk acuity gaps and prioritize lists of “member suspects” based on a year-over-year health condition comparison and other inconsistencies in data
Capture supporting documentation to facilitate care gap chase discoveries for individual members within the solution
Engage providers with pointed interventions by patient so they can easily address all HCC gap issues associated with their practice