View Post

Tackling the challenges of bringing risk adjustment in-house

In 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 …

View Post

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

In 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 …

View Post

NCQA’s Artificial Intelligence Initiatives and Their Impact

In 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 …

View Post

Tackling the challenges of bringing risk adjustment in- house

In 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 …

View Post

COVID-19 Highlights Data Science’s Role in Care for Members with Chronic Conditions

In Care Management, Covid-19, Data Science by Marketing

Data Collection and Analysis Critical in Optimizing Telemedicine A recent article in the American Journal of Managed Care makes the case that COVID-19 provides a strong impetus for expanding the use of clinical registries and virtual care delivery to health plan members with chronic diseases. The physician authors outlined a paradigm that incorporates “real-time clinical registries…a range of synchronous and …