October 04 2017 | 0 Comments | 104 reads Average Rating: 3

Poll Participants Crystal Ball Their Risk Adjustment Future

by SCIO Health Analytics in Risk Adjustment

During a webinar titled Risk Adjustment Round-Up: Reviewing the CMS Call Letter and Other Trends, Pam Klugman of SCIO Analytics explored how Medicare Advantage Organizations can succeed under the new rules and regulations that were outlined in the final 2018 Call Letter.

The webinar also provided participants with the opportunity to offer insight into how their organizations are planning to cope with the pending changes. The following was uncovered via opinion polls that were conducted in real time during the online webinar:

Figure 1: Predict the EDPS/RAPS Blend for PY 2019, SCIO Health Analytics, 2017

The CMS Call Letter indicates that Risk Adjustment Payment System (RAPS) will be valued at 85%, and Electronic Data Processing System (EDPS) will be weighted at 15% for the 2018 payment year – which represents an unexpected rollback to an increased emphasis on RAPS. It looks as if respondents believe that the focus on RAPS will hold on for a while, as 31% of respondents are predicting a 15% EDPS/85% RAPS mix and 39% are predicting a 25% EDPS/75% RAPS mix for 2019. The upshot? Plans should zero in collecting and submitting CPT codes.

Figure 2: Biggest challenge facing your risk adjustment/quality programs, SCIO Health Analytics, 2017

As health plans adapt to the changes outlined in the CMS letter, leaders realize that they will need to focus a variety of challenges. What is weighing most heavily on respondent’s minds? The need to work together. Indeed, 34% of respondents cited payer/provider collaboration as the most pressing challenge facing their quality programs. Indeed, as these organizations move toward value based models that emphasize outcomes, they are acknowledging that they need to concentrate on shared goals.

Figure 3: Measuring the results of your risk adjustment program, SCIO Health Analytics, 2017

As health plans adapt to change, they are most concerned with getting positive results from their risk adjustment programs. While 36% of respondents indicated that their plans use automated monthly reports and 23% leverage a software solution, 36% said that they are still measuring results of risk adjustment programs via manually pulled results and spreadsheets. Many of these health plans are likely to consider how to best leverage technology solutions as they continue to seek positive results in the future.

These poll results offer insight into how organizations are regulatory changes and risk adjustment challenges. How is your organization preparing for the payment changes that loom on the horizon?

Download full infographic | Watch on-demand webinar | View webinar slideshare

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Arun Rangamani
SVP, Care Optimization and SCIOXpert Services

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President, Niloff Healthcare Strategies, LLC

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Vice President, Analytics

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Director of Population Health Strategy, Oracle Corporation

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President, North America

Subha Vaidyanathan
VP, Technology and Data Management

Taryn Bevilacqua
Compliance Director

Tom Peterson
SVP, Risk Adjustment


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