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April 27, 2023  |  1:30 EST  |  1 Hour

A RISE Association Webinar in Partnership with Centauri Health Solutions

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Would You Water Your Garden With A Leaky Hose?

We are continuing the interactive discussion we started at RISE National 2023 about data hygiene and the importance of performing a holistic assessment of data and revenue leakage as part of an overall data governance strategy for risk adjustment using a “leaky hose” metaphor, with the claims universe being the “faucet” end of the hose and risk adjustment operations being the “nozzle” end of the hose. Our discussion included many of the typical reasons for the holes in the hose that cause risk adjustment data and revenue leakage, and an overview of how to address them. We also discussed the need for both concurrent and retrospective data governance strategies to manage leaks, and how to empower providers related to non-clinical improvement activities designed to prevent and address leaks.

The Golden Questions were revealed as we concluded our discussion, and so now we focus on how one health plan answered the Golden Questions:

  • Why don’t you have a claim for every diagnosis?
  • Why don’t you have all of the diagnoses on the claims?

The focus of this webinar will be a case study of how one health plan undertook this assessment of their risk adjustment “garden” and translated their leakage analysis into action, and the result – the “harvest”. Assessments such as these are more important than ever given the recent RADV announcement, the MA Advance Notice, and even the OIG presentation at RISE National 2023 to ensure your data governance strategy addresses the Golden Questions, and also the question of “Why are our claim costs so high but our RAF is so low?”

Topics at a Glance:

  • How the health plan decided that they’d had enough of leaky hoses and icebergs, and decided to undergo a leakage analysis

  • A high-level overview of how their analysis was conducted, and what their analysis revealed

  • How they decided on the priority of addressing their leaks and how they answered the Golden Questions

  • A discussion of the outcomes of their new strategies, and of the most critical factors to their success

  • How this analysis also enables health plan and provider education, especially for staff who are new, to compare to industry best practices, or need to understand how risk adjustment affects quality of care and population health

 

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Who Should Attend This Webinar

This webinar is designed to specifically benefit those with responsibilities in the following areas:

  • VP/Directors of Risk Adjustment

  • Risk Adjustment Staff (Analysts, Project Managers, Coders, Auditors, Documentation Specialists)

  • Chief Financial Officers/Chief Operations Officers

  • Actuarial Staff

  • Data Scientists and Informaticists

  • Health Plan Operations Staff (Claims, Enrollment, Provider Systems)

  • Compliance Staff

Top Reasons to Attend This Webinar

  • Learn the strategy to answering the question “Why are our claims costs so high but our RAF is so low?”

  • Understand how a holistic data and revenue leakage analysis is conducted and how to prioritize addressing the leaks that are discovered

  • Learn to confidently answer the two Golden Questions based on the development of a proactive and practical strategy for a profitable risk adjustment “harvest”

  • Gain insights into how to engage providers as a critical part of your overall data hygiene and governance strategy

  • Learn how to use this analysis to establish risk adjustment standard operating procedures based on best practices that promote operational transparency and accountability of all contributing people, processes and technology

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