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February 22 2018 | 0 Comments | 208 reads Average Rating: 3

Poll Results: Who is the Risk Adjustment star?

by SCIO Health Analytics in Risk Adjustment

During a recent webinar titled “The Risk Adjustment Rallying Cry,” Tom Peterson, SVP, Risk Adjustment, SCIO Health Analytics, addressed the overall importance of risk adjustment.

More specifically, he discussed why a variety of departments need to come together and work in unison towards achieving optimal risk adjustment. Peterson also explained why healthcare organizations need to document Hierarchical Condition Category codes (HCCs) or risk missing out on significant revenue. These codes can be used to identify individuals with chronic illnesses and then assign a risk adjustment factor score that figures prominently in determining payment levels.

During the online presentation, attendees assessed how well their organizations were addressing risk adjustment challenges. The following was uncovered via a survey that was conducted in real time during the webinar:

While HCC codes are a critical component of risk adjustment, healthcare organizations seem to be woefully behind in documenting these codes for their patients. In fact, very few organizations have managed to produce HCCs for more than 70% of their patients or members.

In addition to obtaining HCC codes for more patients, healthcare organizations could improve risk adjustment through better payer and provider collaboration. Currently, however, organizations are mostly likely to report only “average” collaboration.

Risk adjustment has a significant impact on how much healthcare organizations are ultimately paid. As such, risk adjustment should be a team effort. Perplexingly, though, the majority of respondents indicated that risk adjustment at their organizations is handled by a single department.

These poll results offer insights into how life sciences companies are leveraging data analytics to gain a competitive advantage to get a handle on the future. How is your organization leveraging predictive and prescriptive analytics?

Download full infographic | Watch on-demand webinar | View webinar slideshare

Also read:

The Risk Adjustment All Stars: Five Key Players by Tom Peterson.

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Arun Rangamani
VP, Payment Services Delivery Leader

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Jodi Siegel, MSHI, BSN, RN (Guest Author)
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VP, Healthcare Solutions

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Director of Population Health Strategy, Oracle Corporation

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Director of Compliance & Risk Adjustment, Scripps Health Plan Services

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