Availity Blog

Risk Adjustment: The Road Ahead


5.09.2016 by AVAILITY


In two recent blog posts, we talked about the promise "Big Data" holds for risk adjustment and some of the challenges health plans face with existing systems and processes. In the final blog of this series, we look at how the Member Assessment application, part of Availity's Revenue Program Management (RPM) solution, helped one large health plan improve the risk adjustment process.

One of the biggest challenges health plans face when launching a new application is provider adoption. Even the most intuitively designed tool will fail to deliver value if providers don't use it. What makes the Member Assessment different from other applications is that it exists within providers' existing workflow on the Availity platform; they don't have to exit and log into another system. One health plan saw the value of this first hand. Just five months after the application deployed, provider adoption was eight times higher than it had been with the health plan's previous risk management tool.

The Member Assessment application improves the risk adjustment process by streamlining the entry and submission of comprehensive quality and risk assessment forms. One of the ways it does this is by pre-populating fields, reducing the amount of data providers must manually key in. It also identifies when key risk adjustment data is missing and sends a secure message to the provider regarding the coding gap. These time-saving features allowed the health plan to realize significant savings, including a revenue lift of $1,532 per-assessed member per year—more than doubling its revenue from completed assessments.

As health plans transition to value-based reimbursement models, ensuring the flow of timely and accurate risk adjustment data is more important than ever. Availity RPM helps deliver this, along with reduced administrative costs and improved provider satisfaction.

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