Prospective Health Assessment Services Provide Actionable Insights into Member Health Status for Risk Adjustment and Quality

Prospective Health Assessment Services Provide Actionable Insights into Member Health Status for Risk Adjustment and Quality

By Nilay Shah, President of Provider Solutions

Why do health plans and provider groups need more information about their members’ health status?

Unfortunately, medical records and claims don’t always present a complete view of the patient’s health conditions and medical needs. To improve accuracy many health plans turn to companies like Advantmed to have a clinician visit a patient and conduct a comprehensive health assessment.

That’s one of the key value propositions of Advantmed’s comprehensive Prospective Health Assessments (PHAs)

In today’s complex healthcare environment, prospective health assessments are more vital than ever. They offer plans an opportunity to gain a robust view of patients and their care needs – a pathway to better manage patient’s health conditions more productively, and help providers deliver more effective care. Our PHAs also help lay the groundwork for developing more accurate reporting documentation, improving patient engagement and compliance, increasing STAR ratings, enhancing disease management, and reducing utilization through patient education and preventive care management.

To develop the most optimal health assessment program, health plans turn to us for advanced strategies to capture quality information, engage patients, improve health outcomes and reduce the cost of care.

Sophisticated Health Assessment Strategies

Advantmed now offers PHAs that are designed to empower health plans, provider groups and risk-bearing entities with actionable 360-degree insights into the health status of member populations. PHAs provide an effective tool for facilitating timely gap closure and improving care management initiatives. PHAs integrate the program needs of both risk adjustment and quality.

Advantmed’s PHAs focus on 1) identifying chronic conditions through an evidence-based medicine screening program, 2) re-capturing and documenting previous chronic conditions, and 3) closing quality care gaps. They provide real-time visibility into assessments and documentation, integrating analytics, physician-chart reviews, and evidence-based screenings to drive higher engagement rates and optimal results.

Members value the flexibility of having the assessment conducted by Advantmed’s highly-trained nurse practitioners in their home, in a centralized Advantmed clinic or in a primary care physician’s office.

Advantmed clients receive:

  • An average revenue increase from $620 to over $1,500 per assessment
  • The patient acceptance rate for in-home visits of greater than 35 percent
  • 100 percent electronic (tablet-based) assessments
  • 100 percent quality audits of all assessments

Advantmed integrates quality measures, including Star measures, HEDIS® and CAHPS®/HOS. The proprietary process involves a comprehensive assessment that focuses on member engagement and clinical profiles to gather the most accurate data.

The ELEVATE! platform allows clients to view project dashboards and drill-down options, including call metrics and detailed call comments, status on non-cooperating members and reason codes. All clinical data and HCCs are hyperlinked within the assessment.

This PHA offering further expands our exceptional portfolio of services and extends our commitment to enhancing financial, clinical and operational outcomes for MA plans and their members.

We welcome your input and feedback.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).