Reenergized After RISE…Now What?

It’s the Wednesday after a jam-packed RISE conference, focused on “Best Practices and Actionable Tools for Improving Risk Adjustment and Achieving Exceptional Quality Performance.”

I am sure I speak for most of my colleagues that attended the Summit when I say, “I’m reenergized, but what should I do first?” The large group sessions and the breakout meetings delivered valuable insights into why the Centers for Medicare & Medicaid Services (CMS) keeps moving the target for both health plans and providers. As usual, the presentations were top notch.

This year, a sea of risk adjustment vendors lined the conference room, each with a solution that touted superior performance in maximizing revenue by applying innovative technology, provider/member engagement strategies, and robust analytics. Bright lights, big graphics, dashboards that actually closed the Healthcare Effectiveness Data and Information Set (HEDIS®) gap for the colonoscopy measure???  So many options, all impressive in their own right, but where do you go from here?

When I attended these events on behalf of my health plan, I would bring a box of pens and a few notebooks, head back home, and try and piece it all together. Without fail, something would get lost in translation, or my presentation back to the executive team on my takeaways left us all wondering how we’re going to prioritize these initiatives, generate buy-in from across the company, and put these strategies to work.

Hearing and sharing best practices with clinicians, analysts, and other thought leaders in the risk adjustment space always proves to be informative, practical, and actionable. There always just seems to be one thing missing – your co-workers and executives weren’t there to hear how important ALL of this is, and decisions continue to be made in a silo, and programs are perpetually designed with a one-dimensional approach to risk, quality, and medical trend management.

Being the only consultant at the conference who wasn’t aligned with a vendor, I was able to take a very agnostic approach to the entire event. I couldn’t help but notice that more providers were in attendance, voicing their concerns about managing data, navigating the complexities for Hierarchical Condition Category (HCC) coding, and still trying to deliver quality care to their patients. I listened to the health plan representatives discuss the challenges of selecting the right vendor partners, making the decision to bring these risk adjustment business functions back in-house, and integrating people, processes, and data across their entire enterprise.

Now that I am back home, and before I head back out to work with clients on their risk adjustment strategies, I wanted to take this time to stress the importance of being thoughtful about which vendors you select, which strategies you choose to pilot, and which operational processes you decide to uproot.

Just remember a few things:

• Trust that what you are doing now is most likely on the right track – it just might need a little face-lift, especially when the final Call Letter is announced.
• Technology enables an organization to launch and manage interventions that support corporate priorities. Making these investments without a solid plan to leverage the tools and analytics will only set you up for disappointment. More often than not, creating the playbook falls on your “To Do List.
• Be confident that you know the basics, and taking your programs to the next level shouldn’t rest on your shoulders alone –  we heard loud and clear that this needs to be a cross-departmental, integrated approach in order to really move the needle.

If you can read the above takeaways and feel confident that you and your organization are on the right path, GREAT- please continue to share your best practices with your industry colleagues.

On the other hand, if you are on information overload and not quite sure how or where to begin, know that Gorman Health Group and our team of healthcare analytics and risk adjustment experts have a proven track record of helping our health plan and provider clients assess, prioritize, and design initiatives that make sense for you and the communities in which you serve.

If you have any questions or would like to hear more about how we can help, please contact me directly at dweinrieb@ghgadvisors.com.

Resources

Whether you rely on multiple vendors or a largely internal team, GHG can help you streamline the execution of your risk adjustment approach, and build a roadmap to ensure you’re keeping pace with CMS expectations in both compliance and health care outcomes. Visit our website to learn more >>

Don’t miss Dan’s presentation next week at the Gorman Health Group 2015 titled “Risk Adjustment: Cracking the Code” where  he will provide key takeaways from the final Call Letter and future implications, discuss vendor selection, management and oversight, as well as Provider Network strategies and the value of collaboration. Not yet registered for the event? No problem, register here today!