The upcoming Affordable Care Act (ACA) Open Enrollment (OE) period presents at least three major challenges for health plans: Legislative changes, double-digit premium increases, and potentially expiring subsidies. To maintain membership and a positive user experience, health plans must carefully evaluate their approach to enrollment, engagement, and retention.
New rules are reshaping OE workflows, while price increases create affordability concerns for members. It’s difficult for
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ACA Risk Adjustment Program
Change Healthcare, Health Fidelity Collaborate to Offer NLP-Driven Risk Adjustment Solution
Change Healthcare today announced that it is collaborating with Health Fidelity to offer a risk adjustment solution that embeds natural language processing (NLP) and machine learning technology into its risk adjustment coding offering to help Medicare Advantage, ACA commercial, and Medicaid payers increase claim accuracy and better address compliance obligations.How AI Can Transform Risk AdjustmentIn today’s value-based environment, health plans are under mounting pressure to submit
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Why Payers Must Invest in Real-Time Analytics to Increase Profitability Against ACA’S Risk Adjustment Program
With the future of the Affordable Care Act in limbo, health payers and providers alike are back to focusing on how to work within that system. And as payers in particular struggle to find avenues to profitability in the ACA’s complex topography, we’ll likely hear more rhetoric about the difficulty of enticing young, affluent Americans to sign up for health insurance.The conventional wisdom of the moment holds that failure to enroll enough of those so-called “healthy wealthies” to offset the
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