Agenda

Risk Adjustment Comparative Overview: Models, Coding, and Documentation for Medicare Advantage

Clinical documentation and accurate coding are critical to ensure accurate payment for providers that are in a risk-sharing relationship. This interactive workshop will provide an overview of MA RAF methodology and the coding impact of the CMS HCC model. We will also explore the ways Risk Adjustment will affect physicians, the connection between patient health and total cost of care, and the importance of prospective coding and provider collaboration.

Welcome & Introduction: How to Maximize Your Virtual Conference Experience

Advocacy, Legislation and Regulation for Risk Adjustment Flexibility

The COVID-19 pandemic continues to cause disruption and pose challenges for health care systems and their consumers. This session will provide a high level legislative and regulatory update that will encompass 2020 finalized changes impacting our industry in 2021 and beyond. While certain flexibilities have been granted to plans to deal with the unique challenges created by the pandemic, there continue to be outstanding issues that have not yet been addressed that will impact the future of the MA risk adjustment program. Join Aldiana Krizanovic as she provides an overview of key legislative and regulatory changes impacting the risk adjustment program as well as advocacy insight into how the health plan industry is working to address outstanding issues disrupting the stability of the MA risk adjustment program.

Panel Discussion: How Health Plans Are Changing to Prepare for and Implement New And Evolving CMS Regulations

Moderator:

Panelists:

RADV Audit Survival “Kit”

What you need to know about RADV and WHY CMS audits

• Financial Implications
• Extrapolation Methodology

• RADV Playbook
• Lessons Learned
• Accurate Coding
• Reducing Risk Mitigation Strategies

Integrating Risk Adjustment with Stars and Quality Strategies

• Breaking the history of siloed programs
• Integration of Data Assets – functional reporting to obtain Stars, Quality and HCC’s
• Integrating common KPI’s and Leading Indicators to marry Stars, Quality and HCC opportunities
• A case study of Diabetic Opportunities

Leveraging Quality Improvement to Boost Risk Adjustment Performance Scores

Quality Improvement departments have been collaborating with Risk Adjustment departments to boost Quality scores for years, however the relationship between these departments should be bi-directional. Quality Improvement organizations have the ability to significantly impact Risk Adjustment scores. This session will explore ways that various Quality initiatives can bolster Risk scores by impacting provider engagement, simplifying member engagement, and streamlining processes to maximize program efficacy.

Interoperability: Bolstering Data Sharing with Providers that Supports Risk Adjustment & Quality

Network Health Risk Adjustment (RA) and Information Systems (IS) staff will discuss the need for provider-payer data exchanges to support revenue and quality initiatives.  Network has evaluated multiple data exchange platforms over the years with limited provider buy-in.  With the CMS payer to member interoperability deadline looming in July, Network has been considering ways to leverage FHIR data protocols to not only share data with our members, but also more efficiently exchange data with our providers.  Network’s IS experts will detail their vision for a comprehensive FHIR data storage infrastructure that will allow for the open exchange of claims, medical record and supplemental quality data.

Risk Adjustment Compliance Demands a Prospective Approach - A Provider Centric Solution for Coding Accuracy and M.E.A.T Adherence

Prospective Risk Adjustment is not just a process time shift but a new paradigm. Health Plans, MCOs and Providers obtain actionable data that permits them to optimize coding to the highest level of documented severity and easily closes the gaps between coding and documentation in compliance with M.E.A.T. criteria at the point of care. Health plans not only improve RAF scores and mitigate RADV exposure but can also proactively manage member care, lower costs, and achieve higher compliance.

Looking Ahead, Moving Forward - Innovative Health Plan Responses to the Challenges of COVID-19

The session will provide an understanding of the challenges posed by the COVDI-19 pandemic the stages set for future member engagement. We will cover: 1) The disproportionate effects of COVID-19; 2) Impact of Deferred Care from 2020; 3) The emergence and acceptance of digital health technologies. Additionally, we will be taking “A Look ahead to understand what plans should consider to successfully navigate post COVID-19 with a look at expansion and quality of delivery opportunities.” The session will conclude with a forward thinking perspective looking at some innovative solutions plans recently undertaken along with options to advance quality support to members and providers.

Close of Module#2 - Virtual Reception in the Exhibit Hall

Revamping Risk Adjustment with Telehealth

While the COVID-19 pandemic required nimble pivoting to provide member care, it also re-shaped health care delivery with the utilization of telehealth.  Telehealth has become a vital instrument in risk validation to preserve revenue targets.  This session will focus on key strategies to effectively utilize telehealth in supporting risk adjustment activities.

• Discuss vendor utilization for capture rates
• Review strategies for successful telehealth programs
• Examine the impact of COVID-19 on telehealth

Case Study: Value-based Contracting to Optimize Revenue Streams Through Real-time, Concurrent Code Review -- A Win-Win Partnership Between a Payer and their PCPs

Value based contracting is becoming increasingly prevalent in the health care industry.  This session will focus on risk adjustment based contracting between payer and PCP in a network model.  Hear progress, challenges and lessons learned from CDPHP’s innovative partnership with their primary care providers and learn how these win-win arrangements can be operationalized.  Gain insights in how real-time, concurrent code review can optimize revenue streams for both parties and reduce RADV audit risk.

Capturing Social Determinants of Health Using “Z” codes

Hospitals and health systems are desperately working to address the social needs of their patients as well as the social determinants of health within the communities that they serve.  This includes conditions such as food, housing, transportation, education, violence and more.  One way to do this is by using ICD-10_CM “Z” codes to capture the robust data related to patients’ social needs and those in the community.  Join us for this session to see what efforts are needed to improve the health of your patients and the community.  Find out ways to employ a standardized approach for screening, documenting and coding the social needs.  Most of all, come prepared to share what your company is doing to capture SDoH.

Break

RA Coding BEFORE the Patient Visit

HCC coding has traditionally been performed on a retrospective basis. This session will highlight how HCC coding can be performed prospectively, before the patient is seen and the benefits of doing this method.

Provider Engagement Strategies to Achieve Accurate Coding & Documentation

This session will focus on at time of care technologies to assist with HCC capture activities. We will also cover the importance and difference between Payor and Physician incentives from both a Shared Savings/ VBR and Individual Program perspective. Last but not least review return on investment when investing in clinical staff to assist with provider engagement through clinical review and ongoing education and reporting.

Close of Conference