April 11 2017 | 0 Comments | 57 reads Average Rating: 3

Poll provides insight into how organizations are addressing Medicare Advantage plan risk adjustment

by SCIO Health Analytics in Risk Adjustment

During a recently held webinar titled Navigating Risk Adjustment Headwinds in 2017, Pam Klugman of SCIO Health Analytics, explored the risk adjustment landscape and key trends that will impact Medicare Advantage health plans and provider groups in 2017. During the presentation, Klugman discussed the shift toward encounter data, recalibration of the CMS-HCC Risk Adjustment Model and the potential use of vouchers in Medicare.

The webinar also provided participants the opportunity to offer insight into how their organizations are faring with various risk adjustment challenges. The following was uncovered through the opinion poll:

#1 More than half of the respondents (60%) indicated that their organizations have hit at least the half way point when it comes to implementing the changes needed to support EDPS/RAPS. This level of involvement indicates that respondent organizations most likely realize that EDPS can have a significant impact on the bottom line and are looking to properly navigate the change to this new system.

Figure 1: Implementing changes needed to support EDPS/RAPS, SCIO Health Analytics, 2017

#2 The great majority (69%) of respondents did not have knowledge of the status of the discrepancy between their organization’s RAPS and EDPS scores. Unfortunately, without knowing the difference between these two scores, it’s difficult for organizations to know exactly where they stand and exactly how big of a challenge it will be to support EDPS/RAPS.

Figure 2: Discrepancy between RAPS and EDPS scores, SCIO Health Analytics, 2017

#3 Nearly 7 of 10 respondents (69%) predicted that the Affordable Care Act would be repealed but they have been proved wrong. The repeal made headlines virtually every day until its fate was decided recently with the collapse of the healthcare bill and ACA has now become the law of the land. Irrespective of the outcome, value-based care models such as Medicare Advantage appear likely to play a prominent role in the future – and there will most likely be time to adjust to shifting payment structures.

Figure 3: Predicting the future of the affordable care act, SCIO Health Analytics, 2017

These poll results offer insight into how organizations are faring with addressing Medicare Advantage plan risk adjustment. How is your organization dealing with it – and what are you doing to tackle the challenges?

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