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5 Strategies for an Effective Risk Adjustment Program

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Struggling to understand where your risk adjustment program is lacking?

With a reenergized focus from regulators to reduce improper spending, health plans need a strong risk adjustment program that can withstand stricter standards. Here’s how Inovalon’s Converged Risk™ software helps health plans effectively manage new and future reporting requirements.

Strategy 1

Converge Your Risk Adjustment Operations

Get a solution that can enable a comprehensive risk adjustment program.

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Member EngagementCoordinate across quality and risk outreach to ensure that the right member gets the right interaction at the right time.

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Provider EngagementEnd the frustration of managing complex valuebased care arrangements while building provider trust.

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Gap IdentificationUncover hidden gaps and ensure full reimbursement for your members’ risk burden with complete visibility.

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Claims SubmissionsTake the headache out of the final mile of submitting risk adjustment data so your plan can get accurately reimbursed.

Strategy 2

Forecast Your Financial Impact

Gain a full view of every step of your risk adjustment program.

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Utilize Accurate AnalyticsCorrectly identify the members to target.

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Consolidate ProgramsStreamline processes to decrease vendor investment.

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Achieve Greater ImpactReach your desired risk score accuracy outcomes.

Strategy 3

Smarter Analytics and Insights

Efficiently target members with chronic conditions to make the most significant impact on your member population.

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Tailored to Your GoalsControl which conditions and members you target.

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Informed by Confidence LevelsTarget risk gaps by confidence levels to enable controlled intervention thresholds.

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Powered by Expert AnalyticsRisk gaps are informed by machine learning with clinical oversight.

Strategy 4

Faster Risk Score Accuracy

Use a top-shelf digital solution for a smarter, easier, and more efficient approach to risk score accuracy.

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Shorter Analytics RunsUpdate your program throughout the year.

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Quicker Data LoadsLaunch your risk score accuracy program faster.

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Streamlined ConfigurationConsolidate analytics execution across programs.

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On-Demand RefreshesVisualize how your program is progressing and adjust.

Strategy 5

Develop a RADV Audit Strategy

Establish a compliance program that validates diagnoses before an audit is conducted.

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Standardized Data CollectionCreate a consistent documentation process to streamline data ingestion and integrations.

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Provide Internal Audit FeedbackDevelop feedback and education programs to prevent future coding irregularities and errors.

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Conduct Regular Education SessionsInstill the importance of data accuracy with healthcare providers, ensuring everyone is “on the same page.”

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Leverage Digital ToolsTransform data extraction and analysis with artificial intelligence to better capture, ingest, and apply electronic health records.

Set Your Providers Up for Success

Improve quality outcomes and value-based care performance by giving providers the patient-level data they need.

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Inovalon and design® and Inovalon® are trademarks of Inovalon, Inc.

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