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NCQA Alters Telehealth Standards in Wake of COVID-19

In Affinite Quality, Covid-19, HEDIS & Quality Management by Marketing

The complications in care delivery brought about by COVID-19 has prompted NCQA to adopt significant changes to more than three dozen of its widely used HEDIS® measures governing telehealth. In a previous post, we discussed how with the right data tools Quality and Care Management teams can prioritize members with chronic diseases who would benefit from treatment and outreach provided …

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Tackling the challenges of bringing risk adjustment in-house

In Affinite Risk, Risk Adjustment by Marketing

Challenge #2: Infrastructure This is the second in our multi-part series on how health plans can overcome barriers to and reap the rewards of in-house risk adjustment. Click here to read Part 1, dealing with process complexity. Performing risk adjustment operations in-house is an infrastructure-heavy proposition. It requires teams of analysts, coders and their managers, and provider outreach staff. Beyond …

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COVID-19’s Emergence in Infants – Impact on Care Management

In Affinite PlanLink, Care Coordination, Care Management, Covid-19 by Marketing

With the emergence of positive COVID-19 cases in infants over the past several months, how should the care manager support expecting and newly delivered moms in their efforts to keep themselves and their babies safe from COVID-19?  A two-pronged approach that allows the mom to voice her concerns and fears while arming her and her household with the information they …

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NCQA’s Artificial Intelligence Initiatives and Their Impact

In Affinite Quality, HEDIS & Quality Management by Marketing

Payers move to Affinitē Quality to Leverage AI in Closing Care Gaps A previous post discussed NCQA’s changes to HEDIS® reporting requirements for the 2020 and 2021 reporting year. Among the key changes is increased acceptance of artificial intelligence (AI). For the first time, HEDIS is allowing artificial intelligence applications to read scans in diabetic retinopathy screening for comprehensive diabetes …

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Tackling the challenges of bringing risk adjustment in- house

In Affinite Risk, Risk Adjustment, Thought Leadership by Marketing

Challenge #1: Complexity There’s no doubt about it – risk adjustment is complex. This is true whether the product line is Medicare Advantage, commercial insurance, or Medicaid. The complexity of the risk adjustment models and the challenge of collecting accurate encounter data drives many insurers to hire vendors to conduct risk adjustment work. Outsourcing, however, is an imperfect solution that …