George Platt, MSOM, PAHM
Chief Executive Officer and President
Health Plans Rely On Affinitē™ Risk for Hierarchical Condition Category (HCC) Risk Adjustment
Designed by clinical experts, Affinitē™ Risk provides high-value insights into member-specific HCC gaps, risk scores and provider performance.
Managing Hierarchical Condition Category (HCC) risk for your plan’s members can be challenging. For starters, bi-annual updates to the HCC model for risk adjustment 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 trigger an audit. 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 related to HCC’s – 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 member care gaps. This practice could negatively impact your plan's overall 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 HCC gaps to investigate – 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 CMS 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 HCC 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 HCC's and focus 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