population health risk adjustment HEDIS

– by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment 

Leading healthcare organizations are developing strategies to align their programs and streamline the process of gathering crucial data to better serve beneficiaries. With the goal of achieving population health, managed care organizations must fundamentally understand members’ needs and risk. Significant focus and resources are now being applied to the question: Can our organization gather data in real-time and proactively assist beneficiaries in achieving positive health outcomes? 

In September, 2023, CMS announced the AHEAD Model, a funding opportunity for states with the goal to improve the total health of a population and lower healthcare costs. States will be required to assume responsibility for managing healthcare quality and costs across all payers, including Medicaid, Medicare, and commercial lines of business. This includes ensuring that providers deliver high-quality care, improve population health, offer more comprehensive care coordination, and advance health equity by supporting underserved beneficiaries.

In consideration of this opportunity with states, health plans and providers must determine and assess their readiness to achieve management of a population. Managed care organizations (MCOs) and providers need to work together to assess and prospectively address population needs. Together, MCOs and providers can support each other’s data and information needs.

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Stay on top of trends related to how risk adjustment evolves to capture the complexities of health and well-being. ATTAC Consulting Group has the expertise and experience to keep accuracy of risk scores in the forefront of your organization’s risk adjustment program. With a pulse on the latest CMS and OIG trends, and the knowledge of where to look, ATTAC is uniquely positioned to aid in your organization’s risk adjustment programs.