• Share
  • Email
  • Embed
  • Like
  • Private Content
RISE Provider Engagement for HCC Risk Score Management
 

RISE Provider Engagement for HCC Risk Score Management

on

  • 887 views

 

Statistics

Views

Total Views
887
Views on SlideShare
877
Embed Views
10

Actions

Likes
0
Downloads
0
Comments
0

2 Embeds 10

http://www.linkedin.com 7
https://www.linkedin.com 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    RISE Provider Engagement for HCC Risk Score Management RISE Provider Engagement for HCC Risk Score Management Presentation Transcript

    • provider engagement
      • wayne pan md
      • preedar oreggio md
    • agenda
      • why?
      • how?
      • getting their attention
      • who to involve?
      • when to start?
      • what's at risk?
      • follow up
      • q&a
    • why?
      • can you effectively manage a Medicare risk adjustment program without provider engagement?
      • yes, but it involves building a network of providers who can review and document the work that providers are doing - redundant and expensive
    • why?
      • can you effectively manage a Medicare risk adjustment program without provider engagement?
      • no , because provider documentation is the foundation of risk adjustment and provider engagement is essential
    • how?
      • set clear expectations
      • establish mutual goals
      • data, data, data
        • timely
        • quantifiable
        • changeable
      • education
    • incentive programs
      • nothing is free
      • fee-for-service model - pay for services performed
        • annual refresh examination and documentation
        • providing charts for documentation auditing
    • incentive programs
      • capitation model
        • annual HCC bonus based on
          • benchmarks for process
          • benchmarks for risk scores
    • who?
      • which physicians: PCPs vs specialists vs hospitalists?
      • office staff
      • member services
      • nurse case managers
    • when?
      • timing is everything
      • cms data reporting schedule: sweeps
    • what's @ risk?
      • under reporting
      • under documentation (over reporting)
    • follow up
      • close the loop
      • how is provider efficacy communicated?
      • progress reports (static)
      • provider dashboards ("real-time")
      • how well is your program working: benchmarks?
    • bench marks
      • compare to last year
      • % chronic hcc's rolled-over
      • % patients with annual hcc refresh visit
      • % of algorithm identified "suspect" codes captured
      • is there a true hcc benchmark?
    • ?
    • thank you