RaeAnn Grossman.

Risk Adjustment: Are you driving a Pacer or an Audi R8?

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How can you tell if your risk adjustment program is a high performance machine?
Here is the quick test:

1. Did you hit your volume target for member evaluations for 2011?
2. Did you hit your revenue target for chart review and member evaluations for 2011?
3. Are you planning for a 2012 Quarter 1 launch for member evaluations?
4. Do you have best in class analytics with a constant 5 to 1 ROI or higher for member evaluations?
5. Are you reducing your dependence on chart review?
6. Are you scrubbing your claims based HCCs for validation & confidence levels?
7. What is your percentage of zero HCCs found in your member evaluation program?
8. What is your percentage of zero HCCs found in charts?
9. Do two different coders agree on your findings?
10. Are any of your vendors on corrective action plans with you?

We have a few more questions for you. If you want to morph your program into a high performance machine, now is the time for best practices discussion, strategic planning, and program improvement.

RaeAnn Grossman.

About RaeAnn Grossman.

RaeAnn Grossman is one of the nation’s foremost experts on risk adjustment strategies and provider and payer alliance configurations, along with healthcare business and product development. She brings Gorman Health Group more than twenty years of professional experience in a wide variety of healthcare organizations including Health Plans, Medical Groups, Physician Hospital Organizations (PHOs), Integrated Hospital Systems, and Institute of Health Professionals Education. Read more

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