Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment.
The January 2023 rule from CMS, which struck the fee-for-service adjuster from risk
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Cotiviti
Risk Adjustment 2023: Which Vendors Drive Value in a Shifting Market?
What You Should Know:
Strategies employed by payers, provider-sponsored health plans, and provider organizations are starting to become more proactive, and the need for solutions with prospective, predictive capabilities is rising. Additionally, amid rising healthcare costs and economic uncertainty, organizations are looking for solutions that deliver more for less.A new KLAS report examines risk adjustment vendors’ abilities to drive outcomes and value, their prospective capabilities,
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Why Health Plans Are Vital to Health Equity
In Florida, where Black residents are three times more likely to be hospitalized or die from asthma-related complications than white residents, one researcher’s efforts to “strip away the jargon” related to asthma treatment strengthened patients’ engagement in a year-long clinical trial. The impact: development of an asthma regimen to help combat disparities in asthma management and outcomes.
The results are one example of the gains that can be made in addressing health inequities—differences
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Raising Clinical Outcomes and Engagement Through Healthcare Equity: What Health Plans Need to Know
Structural racism and poverty are correlated with a higher incidence of obesity among Black Americans (49%). Social drivers of health, which impact a disproportionate number of non-white Americans who live below the poverty line, account for as much as 90% of individuals’ health outcomes.
These are just two examples of data that highlight the need for equity.
Health plans are well-aware that shifting this dynamic and boosting clinical outcomes is possible through better,
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Gleaning Insights for COVID-19: Why Claims and Clinical Data Matter
Healthcare organizations continue to rely heavily on data analytics to try to improve COVID-19 outcomes and public health. Since the novel coronavirus became widespread in the U.S., healthcare data scientists have leveraged clinical and claims data to pinpoint which underlying conditions put patients at higher risk of complications from COVID-19. Health systems are mining clinical data to predict surges in COVID-19 cases and looking at key factors—including increases in hospital website traffic,
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New COVID-19 Tracker Predicts Future Hot Spots Over Next 7-10 Days
What You Should Know:
- Cotiviti unveiled its COVID-19 Outbreak Tracker to map future infection “hot spots” that may emerge over the next seven to ten days across the U.S.
- The COVID-19 Outbreak Tracker identifies potentially hidden outbreak areas by analyzing COVID screening trends across the millions of medical claims processed through the company’s Caspian Insights platform.
- Forecasting future surges of infection is critical for flattening the curve now, especially considering
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How AI-Driven Insight Could Fuel Medicare Advantage Success
Medicare Advantage plans need more than consumer-centric design, payer/provider alignment, and strong connections across the continuum of care to drive value. The high-value performance also depends on their ability to use data to make a meaningful difference in members’ health.
With 11,000 people aging into Medicare daily, proficiency in managing Medicare Advantage populations is critical for demonstrating value in a competitive market. Enrollment in these plans is growing significantly,
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Cotiviti Launches Longitudinal Data Set in Healthcare
- Cotiviti has launched Caspian Insights, which represents the most comprehensive data set in healthcare and includes longitudinal data on 40% of Americans.
- Unlike other platforms, Caspian unites financial and clinical information with other data types (i.e. social determinants of health, pharmacy, dental, and labs) creating a “single source of truth” never before seen in healthcare to this scale.
- By offering an all-encompassing view of each member, Caspian gives health plans and
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3 AI Trends for 2020: Moving Beyond Dazzle to High-Impact Collaboration
From the first artificial skin to driverless cars that navigate busy streets with ease, 2019 brought a dazzling array of artificial intelligence (AI) discovery. In 2020, the progress made toward AI-fueled collaboration will be as critical as AI innovation—especially in healthcare.
We’ve reached a point where AI has proven its utility. In radiology, for example, AI is well-oriented to interpret diagnostic imaging studies, with FDA approval given to AI algorithms that diagnose a collapsed lung or
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Executive Insights: Top Healthcare Predictions & Trends to Watch in 2020
As we close out the year, we asked several healthcare industry executives to share their predictions and trends for 2020.
Robbie Hughes, Founder, and CEO, Lumeon
“Following the announcement of the Trump administration's price transparency requirement – and the ensuing backlash from hospital groups – the issue of price transparency will dominate the healthcare industry next year. Regardless of the outcome of the lawsuit, I expect we'll see more attention around the importance of the
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