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AdvantmedBlogRisk-Bearing Providers Gain Strategies for Optimizing Risk Adjustment, Quality and Care

Risk-Bearing Providers Gain Strategies for Optimizing Risk Adjustment, Quality and Care

23 October 2018

Advantmed releases “Rise of Medicare Advantage Plans and its Implications for Risk-Bearing Healthcare Providers,” the second in a three-part series, “High Priorities for the U.S. Healthcare System: Powerful End-to-End Solution to Integrate Patient Care.”

Advantmed’s new white paper, “Rise of Medicare Advantage Plans and its Implications for Risk-Bearing Healthcare Providers,” examines trends driving the growing adoption of Medicare Advantage (MA) plans, provider opportunities and challenges in the increasingly value-based healthcare system, and offers innovative strategies for risk adjustment, quality and care management.

Learn about innovative approaches designed to meet growing demand for effective risk adjustment, quality and care strategies.

Effective Value-Based Strategies

Provider-led organizations are taking on risk but without gaining some of the benefits that MA plans have had, especially when it comes to risk-adjustment models.

Knowing how CMS uses Hierarchical Condition Categories (HCCs) to calculate expenditure benchmarks or PMPMs is critical for a risk-bearing provider’s ability to earn shared savings while avoiding shared loss.

Because MA plans have been able to optimize the HCC methodology with significant financial success, providers are well advised to study their methods.

Independent practice owners and health systems can gain highly relevant knowledge about operational viability and how to improve patient outcomes at reduced costs.

Practices that succeed at making the shift from fee-for-service to managing risk are routinely able to increase their practice profitability by at least 25 percent.

Innovative Solutions for Risk-Bearing Challenges

Advantmed’s powerful end-to-end solution integrates with patient care to help managed care organizations improve outcomes by delivering the optimal combination of capabilities designed to meet key objectives, including risk adjustment analytics, software containing NCQA-certified HEDIS® measures, medical record retrieval, medical record abstraction, in-home assessments, risk adjustment coding and provider education.

Want a more robust view of members and their care needs?

Advantmed’s Prospective Health Assessments (PHA) lays the groundwork for developing more accurate reporting documentation, improving patient engagement and compliance, enhancing disease management, and reducing utilization.

PHA also provides a full-spectrum, end-to-end approach to care to help providers identify gaps in care and manage patients more productively.

The greatest benefit goes to the patient, who will be guided toward more preventive care and self-management early in the care process.

To learn more click here.

Learn more about our solutions today

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