Vital Data Technology, a data science- driven healthcare technology solutions provider has launched Affinitē Risk™, a comprehensive, purpose-built application that allows health plans to efficiently and accurately perform risk adjustment processes in-house.
As health plans seek to reduce costs, minimize provider abrasion, and optimize risk adjustment revenue, many health plans are choosing to move risk adjustment operations in-house rather than outsourcing related business processes to one or more vendors, or relying on general analytics offerings. Affinitē Risk provides health plans with the data-analytics insights and tools risk adjustment professionals need to make accurate strategic decisions and identify opportunities to close HCC gaps. Plans have real-time information on risk scores and HCC gaps at both the member and provider level.
“While conducting risk adjustment operations in-house offers benefits such as tighter control over revenue, compliance, and care quality, it can be difficult to execute,” stated Peter Janelle, Vital Data Technology’s Director of Risk Adjustment Solutions. “Affinitē Risk changes that by not only highlighting—in real-time—unaddressed gaps that lower risk scores, but also prioritizing them based on their impact. Additionally, we can customize the metrics to match each plan’s target conditions and interface with electronic medical records, making chart suspecting easier and more productive. As they close gaps, data analysts and managers can add supplemental data directly into Affinitē Risk; the system automatically transforms it into the required formats for encounters submission.”
Janelle explained that other solutions focus solely on supporting specific operational or transactional aspects of risk adjustment such as chart retrieval, coding, and encounters file creation. Affinitē Risk, on the other hand, connects these processes to transform the risk adjustment workflow into a strategic advantage. Eliminating much of the time-consuming manual gap and provider performance analysis is key to allocating resources that can improve – not merely maintain – risk scores. These capabilities are embedded in the Vital Data solution.
Affinitē Risk makes Implementing Risk Adjustment In-House more efficient in a number of ways:
- It computes risk scores daily, spotlighting ongoing member and provider-level opportunities that apply to Medicare or Exchange populations throughout the data collection period.
- It helps plans achieve higher overall RAF by targeting specific categories offering the highest potential for improvement.
- It arms health plan staff with real-time forensic analysis of risk acuity gaps and prioritized lists of “member suspects” based changes in health conditions and other inconsistencies in data
- It captures supporting documentation to facilitate care-gap discoveries for individual members.
- It engages providers with pointed interventions by patient so they can address all gaps within their practice
“Affinitē Risk…automates processes to transform risk adjustment into a strategic advantage. Eliminating much of the time-consuming manual input, gap analysis and remediation, and provider outreach is key to allocating resources that can improve – not merely maintain – risk scores.”By: Peter Janelle, Director of Risk Adjustment
The cloud-based Affinitē Risk module operates as a stand-alone solution or in tandem with other Affinitē products to provide one end-to-end solution for healthcare plans aligning care management, provider alignment, member engagement HEDIS, and risk adjustment.