A 3% Annual RAF Improvement isn’t Nearly Enough.
Depending on the individual risk sharing arrangement, CMS will cap annual risk score improvement to a 3% RAF lift over the benchmark for a population. This can lead to a very common assumption, that 3% can be used as an obvious, un-nuanced goal for risk adjustment strategy each year. Unfortunately, this is incorrect. Fortunately, we’re […]
Machine Learning in Healthcare and the Value of Human Expertise
When discussing artificial intelligence like NLP, the use of machine learning in healthcare inevitably comes up, so today we’re going to clearly articulate what machine learning is, and how it can be best used. First, when people say machine learning (ML), they usually think of “unsupervised,” that is to say, build a machine learning algorithm, […]
ACO Benchmark Calculation: Successfully Understanding the two Levers of Cost and Risk
Our latest ebook, Pulling Both Levers: A Four-Year Analysis of Medicare Cost and Risk Adjustment, unpacks the critical, and often overlooked, importance of effective risk adjustment done in conjunction with medical expense reduction under value-based care.
Forward Looking Opportunities of NLP in Healthcare
An in-depth look at how our technology stack processes information from our NLP engine, Lumanent Insights, to derive clinical suspects and deliver them to providers.
Identifying Risk Adjustable Telehealth Patients in a Post COVID-19 World
Health Fidelity looked for a way to harness our expertise to assist our payer and provider partners provide continuity of care to their chronically ill patients. We decided to help providers identify and prioritize those patients who would be best served by telemedicine via a simple and quick suspecting report.
Value-based Care is Here to Stay: The Path to Accurate and Complete Risk Capture
As providers take on increasing levels of risk, they need to understand the maturity of their processes, the workflows they need to optimize, and the levers they can pull to improve their risk adjustment outcomes. Find out how our risk capture maturity model can help you plan your improvement path forward.
Value-Based Care is Here to Stay: Key Strategies for Developing a Risk Adjustment Program
Our comprehensive, encounter-centric framework helps providers develop an effective risk capture program to achieve success in value-based care.
Clinical Data Acquisition with Technology
Vast amounts of clinical data are generated daily, but traditional methods of collecting and making use of it are inadequate. Adam Gronsky explores options for risk-bearing entities to invest in technology-enabled solutions that require minimal maintenance and decrease the need for manual retrieval in this month's post.
Uncovering Hidden Risk Profiles
Health plans face multiple issues that can lead to an inaccurate portrayal of patient acuity and unidentified risk. With an eye toward incremental progress, here are a few strategies for risk identification improvement.
Why Clinical Data is a Critical Aspect of Risk Adjustment
With the right technology, the analytical value and insights gained from incorporating clinical data into risk adjustment operations is worth the effort.