Case studies

Winning in Risk Adjustment

Five Steps for Health Plan Executives to Boost Coding Accuracy Efficiency

As the healthcare industry continues to shift from volume-based to value-based reimbursement, health plans are changing the way they do business. Recognizing that the cost of traditional fee-for-service care is becoming increasingly unsustainable, many payer organizations are expanding their risk-based contracting efforts and seeking more innovative ways to help providers deliver better care at a lower cost. The stakes are high and will only continue to grow.

In today’s highly regulated, competitive and increasingly quality-focused market, accurate and timely risk adjustment is critical to payer success, with direct impact on both plan revenue and care quality. Effectively tackling risk adjustment starts with improving coder productivity and accuracy. As a result, payer organizations must look to technology for cost-effective ways to improve coding efficiency and accuracy. This white paper outlines:

  • The state of healthcare risk adjustment
  • Key risk adjustment challenges facing health plans
  • Five technology best practices for improving coding processes and mastering risk adjustment

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