Health Plans so far have been spared much of the financial harm caused by COVID-19. The pandemic has quashed primary and elective healthcare visits, limiting the amount plans have had to pay. But financial headwinds are targeting payers in 2021 and 2022. Most analysts expect health plans to see at least a 5 percent reduction in revenues as a result of COVID-19-Induced risk adjustment challenges.
What to Do Now
Vital Data Technology’s Director of Risk Adjustment Strategies, Peter Janelle, discusses strategies plans can adopt now to mitigate the virus’s impact and recoup some of these expected losses. Peter’s 5-minute video outlines the prospective and retrospective steps to take to put your plan on the best possible footing for the 2020-21 and 2021-22 reporting periods:
- Invest in Telehealth – With in-person care visits logistically more difficult, telehealth will become more ubiquitous.
- Expand Physician Incentives – Add to patient assessment forms and value-based incentives to encourage providers to make data retrieval more efficient.
- Analyze Gaps – Compare telehealth visits with traditional in-clinic visits to determine whether, based on these realities and chart analytics, any alteration of your chart retrieval and review program is required.
- Educate providers on the proper way to record telehealth visits and the hierarchical condition categories (HCCs) they cover.
Quick Action Will Pay Off
Though only a few months remain for plans to implement prospective adjustments for capturing a greater number of codable events, they should not hesitate to do so. Even if these efforts come online too late to make an appreciable difference this year, they will pay dividends in the future. It is likely that COVID-19 will continue to depress care visits well into 2021, depriving physicians of opportunities to record HCCs in person. Preparing them and your team for collecting, coding, documenting, and submitting claims from telehealth visits will go a long way toward returning revenues to pre-pandemic levels.
This last point will be critical moving forward. Plans may not need to worry about it this year or next, but at some point CMS will resume RAVI audits, Peter says “there is a significant likelihood that they will look at telehealth.” So it’s important that plans establish procedures for accessing the telehealth data providers compile and for detecting and correcting errors that are coming through.
Director of Risk Adjustment Solutions
Peter Janelle has more than a decade of experience in health insurance, having worked both for payers and vendors. He has extensive knowledge of Medicare Advantage finance, including risk adjustment, stars, value-based arrangements, and healthcare economics. Before joining Vital Data Technology, Peter was in charge of risk adjustment operations at UCare, a regional Minnesota insurer with books of business in Medicaid, Medicare Advantage, and ACA.
His entrepreneurial approach to product development has been shaped both by this healthcare experience and by his leadership of The Liquor Cabinet, a digital content brand with an iPhone app and a comfortable social media following. In addition to traveling the globe in search of unique liquors, Peter enjoys photography and outdoor adventure. An annual highlight is his annual winter camping trip to northern Minnesota.
Peter holds a Master of Public Policy 0from the Humphrey School of Public Affairs at the University of Minnesota.