Bridging Silos: How Quality and Risk Adjustment Teams Can Drive Shared Outcomes in Medicare Advantage In the evolving Medicare Advantage landscape, plans are under unprecedented pressure to do more with less. They must demonstrate superior clinical outcomes, deliver exceptional member experiences, and maintain precise, compliant documentation all while navigating complex regulatory changes. Yet, despite shared goals, […]
In the evolving Medicare Advantage landscape, plans are under unprecedented pressure to do more with less. They must demonstrate superior clinical outcomes, deliver exceptional member experiences, and maintain precise, compliant documentation all while navigating complex regulatory changes. Yet, despite shared goals, Risk Adjustment and Quality Improvement teams often operate in parallel universes. This organizational separation creates […]
The federal government’s recent 43-day shutdown impacted many facets of everyday life in the United States, including Americans’ health, wellbeing, and access to care. One increasingly vital (yet uniquely vulnerable) component of our healthcare delivery system was adversely affected during the shutdown, yet it received little attention: telehealth. Since the beginning of the COVID pandemic […]
Home The landscape of Risk Adjustment Data Validation (RADV) audits is shifting rapidly. With CMS doubling the number of audits and eliminating past leniencies, health plans must be proactive, not reactive. Here’s a deep dive into what’s happening, why it matters, and how to prepare. The Risk Adjustment Data Validation (RADV) audit process has become […]
Home The Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) model plays a crucial role in risk adjustment for Medicare Advantage (MA) and other health plans. CMS recently released Version 28 (V28) of the CMS-HCC model, which brings several updates that Medicare Advantage (MA) plans need to understand to stay compliant and […]
Home Accountable Care Organizations (ACOs) are at the forefront of healthcare’s shift toward value-based care, aiming to enhance patient outcomes while effectively managing costs. To achieve these ambitious goals, ACOs must adopt comprehensive strategies that extend beyond traditional patient care. This post delves into the essential components that contribute to ACO success, from optimizing […]
Home As the healthcare industry transitions more towards value-based care, optimizing clinical operations within Accountable Care Organizations (ACOs) has become essential for achieving sustainable success. With a focus on process optimization, data utilization, and strategic partnerships, ACOs can enhance patient outcomes and maintain financial stability. This article delves into effective strategies that can help ACOs […]
