Shifts in the managed care landscape have reinforced the need for health plans to engage providers to drive the accuracy of risk scores at the point of care. As health plans and providers adopt value-based reimbursement and risk-sharing models, ensuring the accuracy of risk scores becomes an increasingly integral part of these arrangements. Here are four key elements of a successful risk adjustment provider engagement strategy:

Leverage advanced analytics

Advanced analytics are the foundation of effective provider engagement. Analytics, including identification of ideal target groups, right-sizing reimbursement or incentive models, accurate member panel assignments, and providing timely and accurate feedback to providers are needed in each step of the provider engagement lifecycle.

Use technology and communication channels to meet providers where they are and share data in a mutually efficient manner

There is no one-size-fits-all approach to engaging providers, but sharing data in a scalable and secure manner is paramount. Whether it’s through bi-directional data exchange, uni-directional extracts, use of online portals, or sharing of flat files or spreadsheets, transitioning away from paper forms to tech-enabled data sharing is imperative.

Collaborate with provider-facing functional groups to reduce provider abrasion

Siloed functional groups within managed care organizations may obscure who, how and when various departments are engaging provider groups. It’s important for plans to take a unified and coordinated approach to reduce abrasion and drive operational efficiencies. This approach may take more time upfront but can pay dividends in nurturing healthy long-term partnerships.

Provide personalized feedback and training through chart review to aid the adoption of coding and documentation best practices.

Although mass distribution of diagnosis coding best-practice collateral may be efficient, it may not be the most effective means to drive adoption. Timely and personalized feedback from targeted reviews is a more powerful way to influence behavior change. This personalized approach is resource-intensive and cannot be used across the entire provider network; therefore, use of advanced analytics to allocate scarce resources is critical in targeting and monitoring.

As provider groups and health plans continue to work toward greater collaboration, risk score accuracy is a high priority for both parties. Implementing the right strategy, approach and program for each provider and payer scenario is critical to deliver sustained success. 

Contact ATTAC’s industry experts for additional insights on how to best partner with provider groups and drive accuracy of risk scores.