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by Trey Wheless, Executive Recruiter: Quality Reporting and Risk Adjustment for Health Plans

This article was originally published on LinkedIn –  [View Original Post]

Only six months ago, the healthcare industry looked completely different. COVID-19 has impacted every area of healthcare, resulting in fewer doctor visits, fewer diagnoses, and, therefore, fewer claims. As a result, risk-adjusted programs are now facing an inevitable revenue crisis for the upcoming year.

How are individual health plans mitigating revenue losses and proactively protecting future funding?  I’ve talked with several people at different plans, and it seems there are a few common themes.

1. Telehealth visits mitigate the financial losses that risk-adjusted programs face. Some health plans are increasing telehealth use by focusing on members’ comfort levels with the use of the platform and the onboarding experience. This hands-on approach makes members’ adjustment to virtual visits easier and encourages their continued use of telehealth.

2. Member Engagement allows for tracking member experience and following up on missed appointments. As the second pair of eyes, plans can monitor the health experience of members, which is incredibly beneficial for high-risk members with pre-existing conditions.

3. Provider Education is an initiative that plans are using to ensure providers’ success with Telehealth technology adoption. These education sessions help providers with equipment, administrative processes, and coding.

4. RX Data gathering is a due-diligence measure where plans cross-reference prescription data with chart reviews to ensure that HCC coding is accurate.

While these are the common trends, I suspect that there are other approaches health plans are taking to protect themselves financially.

What other measures can health plans be taking to help protect risk adjustment funds for 2021?


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