Blog en Default 2017 Blog Preview You and your team have a fresh slate for 2017. How will you use it? Follow us for weekly blog posts on how prospective assessments can improve risk scores, close gaps in care and improve Star Rating scores. Thu, 05 Jan 2017 00:00:00 GMT. Default Our Top Five Most-Read Blogs of 2016 Thank you to all of our readers who made 2016 our most successful year for our blog. Thu, 29 Dec 2016 00:00:00 GMT. Default Three Ways to Reduce Health Risks for Adults Age 65 and Older During the Holiday Season With colder weather and an increase in indoor social activities, it’s important to be mindful of health risks to older adults this time of year. Tue, 20 Dec 2016 00:00:00 GMT. Default Best Practices for Leveraging In-Home Assessments to Improve Part D Star Ratings Coordination between Risk Adjustment and Pharmacy teams is critical to impacting five Part D Star Ratings measures. Mon, 19 Dec 2016 00:00:00 GMT. Default New AAPC Chapter Formed for Medical Coding Professionals in Dallas-Fort Worth The chapter will meet at the offices of CenseoHealth in Farmers Branch and offer professional growth opportunities for local coders. Thu, 15 Dec 2016 00:00:00 GMT. Default Important Updates from the CDC for this Flu Season December 4-10 is National Influenza Vaccination Week: A timely topic aimed at raising awareness about the importance of receiving a flu vaccination. Mon, 05 Dec 2016 00:00:00 GMT. Default Thanksgiving Is Also National Family Health History Day Use the holiday time with relatives to have a meaningful discussion about your family’s health history and record the findings to share with your primary care physician. Fri, 18 Nov 2016 00:00:00 GMT. Default Closing the Gap for Diabetic Health Plan Members Diabetes impacts approximately 30 million people in the United States. More than a quarter of those individuals are 65 and older, making this a serious health concern for the elderly population. Mon, 14 Nov 2016 00:00:00 GMT. Default Honoring Our Veterans With Each Assessment CenseoHealth is proud to offer health assessments to veterans of our armed forces. Fri, 11 Nov 2016 00:00:00 GMT. Default 10 Ways to Maintain a Healthy Brain Simple steps you can take to reduce your risk of cognitive decline and Alzheimer’s. Thu, 03 Nov 2016 00:00:00 GMT. Default CenseoHealth October 2016 Physician Spotlight Congratulations to Dr. Lornetta Epps, M.D., who is our Physician Spotlight for October! Thu, 27 Oct 2016 00:00:00 GMT. Default Seven Specific Measures Closed by an In-Home Health Assessment to Improve Star Ratings Whether your organization needs to maintain high marks or is looking for major improvements, prospective health assessments have the ability to really move the needle and close several Part C measures. Tue, 25 Oct 2016 00:00:00 GMT. Default CenseoHealth Celebrates Seventh Anniversary After seven years of success, we take a look back at how we’ve gotten here and celebrate the individuals who have helped us complete more than 1.5 million health assessments. Mon, 17 Oct 2016 00:00:00 GMT. Default Celebrating Women’s Health Four common issues faced by senior women and how an in-home health assessment can help. Thu, 06 Oct 2016 00:00:00 GMT. Default CenseoHealth September 2016 Physician Spotlight Congratulations to Dr. Gary Merrell, M.D., who is our Physician Spotlight for September! Wed, 28 Sep 2016 00:00:00 GMT. Default High Risk Medication Prescriptions and the Impact on a Plan’s Star Rating Two recently updated measures are tied directly to high risk medications. Tue, 20 Sep 2016 00:00:00 GMT. Default September Is Healthy Aging Month Identifying opportunities to reduce health risks associated with growing older while positively impacting HEDIS measures Wed, 07 Sep 2016 00:00:00 GMT. Default CenseoHealth Employees Donate Cash and School Supplies to Support Community Partners of Dallas Thank you to all of our employees who participated in our School Supply and Donation Drive benefiting Community Partners of Dallas—an organization that provides new school supplies for more than 2,500 abused and neglected children in the Dallas community each year. Mon, 22 Aug 2016 00:00:00 GMT. Default CMS Report: ACA Risk Pool Improving On August 11, 2016, the Centers for Medicare & Medicaid Services released an analysis showing slow growth in per-enrollee costs from 2014-2015 resulted in a “broader, healthier risk pool.” Wed, 17 Aug 2016 00:00:00 GMT. Default Why You Should Care About the Coding Credentials of Those Who Perform Your Risk Adjustment Coding There is a way to be proactive and feel more confident about coding accuracy going into a RADV audit: ask your vendors about their team’s coding credentials to see the percentage of coders who are Certified Risk Adjustment coders (CRCs) and do the same with your internal coding team Thu, 11 Aug 2016 00:00:00 GMT. Default CenseoHealth July 2016 Physician Spotlight Congratulations to Dr. Brian Hyman, our July Physician Spotlight, who has provided services to CenseoHealth since 2013. Fri, 29 Jul 2016 00:00:00 GMT. Default Five Reasons Annual Health Assessments Aren’t Just for Chronically Ill Beneficiaries What comes to mind when you think of an annual health assessment? Many consider these evaluations strictly a benefit to home bound individuals who are often unable to leave their home due to chronic conditions. But we have found that even healthy individuals can benefit from an in-home health assessment. Tue, 12 Jul 2016 00:00:00 GMT. Default How Might HEDIS Changes Impact Plans' 2018 Star Ratings Changes in 2017 HEDIS impact three Star Rating measures for Medicare Advantage plans Thu, 07 Jul 2016 00:00:00 GMT. Default You Had to Write a Check to One of Your Competitors…Now What? For individual marketplace and small group health insurance plans, the Summary Report outlining risk adjusted transfer payments for the 2015 benefit year is out Thu, 07 Jul 2016 00:00:00 GMT. Default Celebrate Seniors Keeping Their Independence We live in a new age when it comes to long term care options for people 65 and older. With the use of home-based services becoming more widespread and skyrocketing costs for facility-based long term care, a new generation of Medicare beneficiaries are choosing to remain at home if their health permits. Fri, 01 Jul 2016 00:00:00 GMT. Default #censeohelps The Senior Source with Volunteers and a Donation Drive Thank you to our employees who volunteered with The Senior Source on June 25, 2016, at The Madison on Marsh skilled nursing community in Carrollton, Texas. Fri, 01 Jul 2016 00:00:00 GMT. Default CenseoHealth June 2016 Physician Spotlight Congratulations to our June Physician Spotlight, Dr. Paul Gregg, who has provided services to CenseoHealth since 2013. Wed, 29 Jun 2016 00:00:00 GMT. Default National Safety Month Highlight: Fall Risk Awareness June is National Safety Month and marks a great opportunity to highlight awareness around avoidable accidents at home that result in injuries and even fatalities. Tue, 28 Jun 2016 00:00:00 GMT. Default Three Tips for Maintaining a 4-Star Rating Medicare Advantage members are faced with an overwhelming number of plan choices annually for enrollment which makes it critical that plans achieve a 4-star rating to remain competitive. As plan budgets are tightened each year, the bonus payments for plans with 4 or more stars allow them to offer greater member benefits and help offset some of the premium reductions from the Centers for Medicare & Medicaid Services. Fri, 24 Jun 2016 00:00:00 GMT. Default Give Dad Some Healthy Advice for Father’s Day While spending time with your father this Father’s Day encourage him to consider preventative health actions like an annual wellness visit. Fri, 17 Jun 2016 00:00:00 GMT. Default Why Are Your Network Physicians Bad at Coding? They’re not. They are navigating a system that is not designed to capture complete and accurate information for risk adjustment purposes. The Fee for Service (FFS) payment model is designed to pay physicians for the procedures completed—not the disease treated. Thu, 09 Jun 2016 00:00:00 GMT. Default Serving Those Who Serve At CenseoHealth, we are always looking for opportunities to partner with organizations who align with our mission. In December we held a “jeans week” fundraiser where employees and supporters were encouraged to make a donation to TexVet. Fri, 27 May 2016 00:00:00 GMT. Default CenseoHealth May 2016 Physician Spotlight Congratulations to Dr. John Stripling, M.D., our May Physician Spotlight, who has provided services to CenseoHealth since 2014. Thu, 26 May 2016 00:00:00 GMT. Default Three Tips for Surviving the RAPS/EDPS Transition As the blend percentage changes for data submission to the Centers for Medicare & Medicaid Services’ Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS), it’s imperative your risk adjustment team is receiving complete, timely and accurate encounter data. Wed, 18 May 2016 00:00:00 GMT. Default Six Tips to Coding Nirvana Keeping a coding team running at peak efficiency and turning out the highest quality work can be a daunting task. These six tips can help your team achieve coding greatness and improve the accuracy of their work. Thu, 12 May 2016 00:00:00 GMT. Default Reducing the Risk of Cognitive Decline and Dementia May is Mental Health Month, and we are joining in the conversation by raising awareness around cognitive decline and dementia. Tue, 10 May 2016 00:00:00 GMT. Default Mom's The Word There are few words in the English language that conjure emotions in each of us like the word “mom.” She is many different things to different people. Oprah Winfrey said it perfectly, “Biology is the least of what makes someone a mother.” Thu, 05 May 2016 00:00:00 GMT. Default Member Engagement: Five Tips for Improving Completion Rates Moving the needle on member engagement for a health assessment program can seem like a monumental task, but making a few adjustments and adding layers of outreach can result in a modest lift. Thu, 28 Apr 2016 00:00:00 GMT. Default Ramping Up for Our Community On Saturday, April 23, a group of CenseoHealth employees made a difference in our community by building two ramps in the Dallas area with the Texas Ramp Project—an organization that has constructed more than 11,000 ramps since 1985 for homebound individuals Tue, 26 Apr 2016 00:00:00 GMT. Default The Highlights: CMS CY 2017 Final Call Letter CMS released yesterday the Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The following highlights the biggest changes from the February, 29, 2016 Advance Notice that impact Medicare Advantage (MA) plans’ risk adjustment programs. Tue, 05 Apr 2016 00:00:00 GMT. Default 12/11/15: Flu Shot Friday Update According to the Centers for Disease Control and Prevention (CDC) 1.5 million flu vaccines were distributed last week, bringing the U.S. total to 142 million. “Flu season” in the United States usually runs from October through May. Fri, 11 Dec 2015 00:00:00 GMT. Default 12/04/15: Flu Shot Friday Update Every Friday CenseoHealth is providing an update of the number of flu vaccines distributed in the U.S. — by generating awareness we hope to reduce this season's flu related care costs and deaths. Fri, 04 Dec 2015 00:00:00 GMT. Default CenseoHealth is Proud to Support America's Veterans Wed, 11 Nov 2015 00:00:00 GMT. Default CenseoHealth Awarded No. 3 Entrepreneurial Company in Dallas Metroplex This year is the third time CenseoHealth placed in the top 10 of the Dallas 100. CenseoHealth started with three employees in 2009 and has grown to nearly 400 employees currently, 30% of whom were hired in 2014. Fri, 06 Nov 2015 00:00:00 GMT. Default Member Engagement Wed, 28 Oct 2015 20:38:34 GMT. Default Medicare Advantage Risk Adjustment Tue, 22 Sep 2015 18:33:10 GMT. Default Commercial Risk Adjustment Tue, 22 Sep 2015 18:33:02 GMT. Default Is Your Organization Prepared for the Transition to ICD-10? As the nation transitions to ICD-10 coding on October 1, 2015, health plans and physicians continue to express concerns that it will take time to adapt to the new version of codes. ICD-10 codes, which provide greater specificity to better represent and communicate a patient’s clinical conditions, increased the number of diagnosis codes from 13,000 ICD-9 codes to approximately 68,000 ICD-10 codes. Tue, 22 Sep 2015 00:00:00 GMT. Default Medicare Advantage Star Ratings Wed, 02 Sep 2015 19:54:56 GMT. Default How much are inaccurate risk scores costing you? When HHS released their summary report on reinsurance payments and risk adjustment transfers on June 30, 2015, it became apparent just how important accurate risk scores are to the financial sustainability of health insurance plans that are subject to commercial risk adjustment. Tue, 01 Sep 2015 00:00:00 GMT. Default Happy 50th Medicare & Medicaid! Today marks the 50th anniversary of Medicare and Medicaid, which was passed into law by President Lyndon B. Johnson on July 30, 1965. Today, according to the Centers of Medicare and Medicaid Services (CMS), more than 30 percent of the 55 million Medicare beneficiaries and well over half of the 66 million Medicaid beneficiaries are now in private health plans. Thu, 30 Jul 2015 00:00:00 GMT. Default There's No One Way to Improve PCP Documentation For years health plans have struggled to develop successful strategies to ensure their government payments are aligned with the health of their members. To achieve success, it is critical that each member's diagnoses are accurately documented. What better way to get this documentation than from a member's primary care physician who sees them regularly. Thu, 04 Jun 2015 00:00:00 GMT. Default Impact Critical CMS Star Rating Measures Using Mobile Physician Visits Making it to a Centers for Medicare and Medicaid Services 5-star rating takes multiple approaches. Often thought of as a service designed to collect risk adjustment data, in-home visits also look at quality of care, risk adjustment, member activity level, and social determinants of health. The mobile physician visit is a great way to close and influence critical 5-star Quality Rating Measures. Thu, 04 Dec 2014 00:00:00 GMT. Default Revival of the House Call Middlebury Magazine recently profiled CenseoHealth physician Bob Friedman, M.D., and his experiences in transitioning from a small practice to conducting in-home health assessments. His story drives home the importance of the issues a physician can address in an in-home visit that they cannot in an office visit. Wed, 05 Nov 2014 00:00:00 GMT. Default The Final Push: Simple Q4 2016 Star Rating Tactics As the fourth quarter begins, a final strategy in gap closure opportunities for Medicare Advantage Plans is critical to improving Centers for Medicare and Medicaid Services 5-Star Quality Ratings for this data year. There is still time to make a difference, but a push for five stars takes multiple approaches. Wed, 29 Oct 2014 00:00:00 GMT. Default Home Visits – One Ingredient in This ACO CEO’s Secret Sauce In a recent Vox article, German Lopez sheds light on emerging Accountable Care Organizations. Created by the Affordable Care Act as a means to integrate physicians and improve health outcomes, federal reviews show few ACOs participating in federal programs have achieved significant results. But it’s early and there’s still hope – especially if ACOs follow in the footsteps of MissionPoint Health Partners. Thu, 19 Jun 2014 00:00:00 GMT. Default 4 Vital Strategies For Reducing COPD Readmissions Beginning this October, hospitals will be penalized from the Centers for Medicare and Medicaid Services (CMS) for excessive chronic obstructive pulmonary disease (COPD) readmissions, causing many organizations to scramble to create strategies to manage a patient population that has long since been off their radar. Tue, 03 Jun 2014 00:00:00 GMT. Default New York Times Predicts House Calls to Make a Comeback In today’s issue of the New York Times, Milt Freudenheim wrote that house calls that were once “the norm” up until the mid to late 1900’s are now making a comeback as part of some hospitals’ palliative care programs. Sat, 19 Apr 2014 00:00:00 GMT. Default Moving Forward Post-Call Letter From a risk adjustment perspective, what made this year’s Call Letter interesting was not just what it said, but also what it didn't say. Tue, 15 Apr 2014 00:00:00 GMT. Default Accountable Patients and Members Every type of health plan can benefit from creating a more accountable patient or member. Download the Accountable Patients and Members checklist to get your creative engagement juices flowing. Fri, 17 Jan 2014 00:00:00 GMT. Default 'Beginning of Movement toward Better Outcomes': What GlaxoSmithKline's Marketing Decision Means for MTM GlaxoSmithKline's change in marketing policies indicate a bright new future for medication therapy management – with the patient truly in mind. Mon, 13 Jan 2014 00:00:00 GMT. Default Falls Prevention Awareness Finding a Resurgence Many think falls are an inevitable part of aging, but research shows fall risks can be reduced through interventions. Learn how your quality health organization can educate and impact members, their families and/or caregivers on this issue. Mon, 16 Dec 2013 00:00:00 GMT. Default 2013 in Review: Ideas to Help You Grow From ICD-10 to social media engagement, we've pulled together the top news stories, and ideas from 2013 to help your organization grow. Fri, 13 Dec 2013 00:00:00 GMT. Default Methodology Changes Coming to NCQA Health Insurance Plan Rankings Change is a-comin' to the annual National Committee for Quality Assurance (NCQA) health insurance plan rankings. Simple and more aligned with Centers for Medicare and Medicaid Services Star ratings, click through to find out what else in store with the new rankings. Fri, 06 Dec 2013 00:00:00 GMT. Default Honda and HIX: What Healthcare Exchanges Can Learn about the Customer Experience Honda paints a great picture of how changing the expectation of the customer can create a fiercely loyal and engaged buyer. But how does Honda get its customers to engage the system and what can health insurance exchanges take away from that? Mon, 11 Nov 2013 00:00:00 GMT. Default Costly and Complex: Eight Facts to Help Better Understand Your Members with COPD November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month. A blanket disease that covers lung diseases like emphysema, chronic bronchitis, and non-reversible asthma, the disease is increasingly deadly, complex and costly. Fri, 01 Nov 2013 00:00:00 GMT. Default In Defense of ICD-10 Conversion Hear ye, hear ye -- we've got a case to make! The ICD-10 conversion is coming -- and our infographic shows that it's time the coding world caught up the innovations the rest of medicine has made over the last 30-plus years. [INFOGRAPHIC] Fri, 11 Oct 2013 00:00:00 GMT. Default Start Sooner, Catch Better: What Peyton Manning Has to Do with Home Health Assessments Denver Broncos quarterback Peyton Manning was joined by a new wide receiver this offseason: Wes Welker. The Texas Tech product was a perennial all-star target for Tom Brady and the New England Patriots for years, but after the two sides weren't able to negotiate a new contract and in March, he signed with the Broncos. Fast forward five months, the new teammates are playing pitch and catch like lifelong buddies, connecting for a four touchdowns in the first three weeks of the season. They are the envy of the National Football League. But how'd they get there? Tue, 01 Oct 2013 00:00:00 GMT. Default Surviving Q4: A Brief Guide to Maintaining Your Sanity Accountants have tax season. College students have finals. No matter how hard you work to stay ahead and not procrastinate, busy seasons creep up. For healthcare professionals, the final three months of the year mean meeting tight end-of-year deadlines before greeting a whole new group of enrollees in January. As we sit on the cusp of another fourth quarter, it's important to keep a couple things in mind while forging ahead. Remember these simple tips, keep your nose to the grindstone and you'll come out okay. Wed, 25 Sep 2013 00:00:00 GMT. Default 'Switching the Dialogue': Re-capping the 3rd Annual Dual Eligible Best Practices Summit From implementation to marketing, the resounding message of the 3rd Annual Dual Eligibles Best Practice Summit, held September 16 and 17th in Orlando's Buena Vista Palace Hotel was the movement to a person-focused, or "people-centric" approach to health care. Thu, 19 Sep 2013 00:00:00 GMT. Default Go Low Tech: How to Achieve Real Medication Adherence A pill with a microchip. A bottle with a GPS locator. The Jetson's would be impressed. Tue, 17 Sep 2013 00:00:00 GMT. Default Seeing the Flags: How Health Care Plans Can Drive Better Behavioral Health in Dual Eligibles Perhaps more shocking than the financial impact of dual eligible market – the unique and challenging population that is eligible for both Medicare and Medicare – is the alarming persistence of mental health issues. [INFOGRAPHIC] Mon, 09 Sep 2013 00:00:00 GMT. Default Are Your Partnerships Driving Care? Driving care is something we are passionate about, just like you. We feel the right partnership is key to providing the best care. That's why the Florida Hospital Association's five-year study results were so exciting. The 160-plus Florida hospitals participating in the quality-initiatives saw a 15% drop in admissions, a 14.5% decline in surgical complications and dramatic decreases in infections, including a 41% drop in bloom stream infections and a 37% drop in urinary tract infections. Fri, 23 Aug 2013 00:00:00 GMT. Default MTM may be the single best way to avoid unnecessary complications and hospitalizations Medication Therapy Management (MTM) for seniors, particularly those taking multiple drugs for complex medical problems, may be the single best way to avoid unnecessary complications and hospitalizations in the Medicare population. Tue, 09 Jul 2013 00:00:00 GMT. Default GHG Forum 2013's Hottest Topic: Medicare Part D and MTM If there was one topic that seemed to permeate the 2013 Gorman Health Group (GHG) Forum, that topic would be Medicare Part D or more specifically Medication Therapy Management (MTM). GHG Executive Chairman, John Gorman addressed the topic in his welcoming speech, two of the 22 presentations were exclusively focused on Part D and MTM, and half the presentations mentioned these keywords in at least two of their slides. Thu, 27 Jun 2013 00:00:00 GMT. Default Q&A: Upcoding We recently received this question from a health plan regarding upcoding, see what Chief Medical Officer Dr. Dambro, had to say in response. Wed, 27 Feb 2013 00:00:00 GMT. Default The Future of Medicare Advantage Given the current political climate, I suppose I should not be surprised that Medicare Advantage (MA) is regularly attacked as being a bad bargain for its members, for the government, and for taxpayers. As to the members, seniors seem to have voted. The numbers for the 2013 Annual Election Period (AEP) won’t be available for another couple of weeks, but it is likely that the program will grow to close to 15 million members. Not bad for a program that was supposed to be atrophying into irrelevancy by now, but whether or not the program has real value is worth further consideration. Tue, 12 Feb 2013 00:00:00 GMT. Default RADV Audit Extrapolation Issue Is Back In the wake of recent announcements by the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) regarding RADV audit methodology changes, there has been much uncertainty around how much Medicare Advantage (MA) plans might owe in extra penalties. Wed, 23 Jan 2013 00:00:00 GMT. Default Interview with Physician Evaluator Lance Christiansen, MD “On Call” - where CenseoHealth physician evaluators introduce themselves and share their unique history in the medical field, what led them to CenseoHealth and the experiences they’ve had administering the Advanced Evaluation™. Health Care Blog_12.12.12 Wed, 12 Dec 2012 00:00:00 GMT. Default Focus on Chronic Conditions If you want to align your Medicare Advantage programs further, you should consider focusing on chronic conditions. Looking at the parallel nature of chronic conditions and member admission rates,there are three ways MA plans can better manage these beneficiaries. your Medicare Advantage program_12/07/12 Tue, 04 Dec 2012 00:00:00 GMT. Default If you start after February 1, you may be missing out... We recently surveyed our clients and other health plans regarding their projected HCC and Star Rating in-home evaluation program start date: 42 percent of Medicare Advantage plans or capitated medical groups said they planned to launch by March 1st, and 96 percent of Medicare Advantage plans look to launch no later than May 1st. To stay competitive and offer your members better care in 2013 and beyond, you strongly need to consider starting your program by February 1. start date_11/27/12 Tue, 27 Nov 2012 00:00:00 GMT. Default The Affordable Care Act's Impact on Risk Adjustment Now that President Barak Obama has been re-elected, a couple of questions on everyone’s minds are: What’s next for the ACA? and How will the ACA impact Risk Adjustment methodology? It is possible that the House of Representatives will delay or withhold funding for parts of the ACA, but that seems unlikely... Risk Adjustment_11/19/12 Mon, 19 Nov 2012 00:00:00 GMT. Default Interview with Physician Evaluator Claude Newman, MD Our nationwide network of 10,000 licensed physicians is one of CenseoHealth’s unique characteristics that separates us from other risk adjustment providers. Today we’d like to introduce a new series, “On Call”, where CenseoHealth physicians introduce themselves and share their unique history in the medical field, what led them to CenseoHealth and the experiences they’ve had administering the Advanced Evaluation™. We are excited for you to get to know our physician team and look forward to sharing their stories that truly capture the advantages and successes of the Advanced Evaluation. Health Care_11/15/12 Thu, 15 Nov 2012 00:00:00 GMT. Default Strategies for 2013 Practice makes perfect – and risk adjustment models have seen an immense amount of change over the last several years. As you begin to develop your 2013 risk adjustment strategy these next few months – let’s quickly review what risk adjustment practices are “out” and what strategies you should consider for 2013. Fri, 02 Nov 2012 00:00:00 GMT. Default Contemplating Health Insurance Exchanges? Here's what you can learn from Medicare Advantage Now that the Supreme Court has upheld the Accountable Care Act, states and health plans are forced to contemplate the implications of the insurance exchanges at the heart of that legislation. The exchanges are a hybrid of Medicare Advantage (MA) and Medicaid approaches to risk adjustment with a couple of significant differences from each. Like MA, the exchanges collect the data intended to predict future cost at the member level and, in the federal option, base that prediction on diagnoses. Like Medicaid, they aggregate that data and assign a risk score at the plan level. Also like most risk adjusted Medicaid programs, the system is truly zero sum. Plans with a below average risk score write a check while those with an above average score get a payment. Unlike both, the system is neither retrospective nor prospective. It is concurrent in that the charges and payments are calculated as soon as possible after the benefit year and are applied as soon as they are known with the single exception that payments are not made until charges are collected. Wed, 17 Oct 2012 00:00:00 GMT. Default What MTM Can Do For Your STAR Rating and Medical Cost In approaching the issue of prescribing quality with a robust MTM tool, the approaches outlined in STAR ratings and those of the more general medical cost reduction are definitely complementary. Mon, 08 Oct 2012 00:00:00 GMT. Default Four key ingredients for more efficient health care Risk adjustment and HCC Management are essential activities in Medicare Advantage. Both support the assumed financial risks in Medicare Advantage (MA) and both impact member health care in the immediate and short-term future. HEDIS and Star ratings, as a reflection of quality, are positively affected by risk adjustment activities. Four interacting realms of health care work together to enhance the efficiency of health care delivery. To maximize the impact of health care delivery on member outcomes, each of these realms needs special attention. The four realms are... Thu, 27 Sep 2012 00:00:00 GMT. Default Dual Demos Need to Prove Sen. Rockefeller's Concerns are Misplaced The Dual Eligibles Conference July 30-31 in Orlando had many experts from state governments and national consultancies. Many of whom—Gary Jacobs of PWC being an excellent example—provided a wealth of practical information. Fri, 10 Aug 2012 00:00:00 GMT. Default 9 Pieces of Data Best Collected in Member's Homes At the RISE California conference last week, July 22-24, there was a lot of conversation around how in-home risk adjustments are not just the solution for better documenting member diagnoses (HCC Codes) but also improving members’ quality of care. One of the largest challenges facing the health plan professionals I spoke to at the conference was identifying members with depression and behavioral health AND finding ways to positively affect change. The following are 9 pieces of behavioral health data that can are best collected in the member’s home. Mon, 30 Jul 2012 00:00:00 GMT. Default If I were an ACO… If I were a Medicare ACO and about to launch, I would start looking at my members before launch, during the rate calculation period. I need to make certain I have submitted the most accurate and specific codes to CMS to represent my members’ (patients) true clinical severity thus creating the most appropriate and exact HCC score. Mon, 21 May 2012 00:00:00 GMT. Default Are you the Mario Gutierrez of Risk Adjustment? Mario Gutierrez never rode in a Kentucky Derby before May 5, 2012. He was on a horse that not many knew about - I’ll take Another - and he was given position 19. Does that sound like you? Are you in position 19 with your quality and risk adjustment strategies? Are you out of the starting gate? Are you rounding your first quarter-mile in front of a record crowd? Mon, 14 May 2012 00:00:00 GMT. Default An Interesting (and Ironic) Truth Bales and I were at a health care summit in Dana Point last week organized by Health Evolution Partners. The attendees were a fascinating cross section of senior executives and policy makers in our business, including a number of leaders from plans with primarily commercial lines of business. There was a great deal of discussion about wellness programs and their impact on cost. That got me thinking about wellness and Medicare Advantage. Fri, 04 May 2012 00:00:00 GMT. Default High Value Health Care Consumer Reports and The American College of Physicians recently announced a partnership in pursuit of High Value health care. Simple ideas like using low-cost and well-proven generic medications for common diseases like diabetes (instead of the latest, highly expensive brand drug-of-the-month) and avoiding unneeded imaging studies for acute back pain. Mon, 30 Apr 2012 00:00:00 GMT. Default Complex Medications and MA I saw an interesting press release from Health New England yesterday. You are probably painfully aware that the 30-day readmission rate in Medicare Advantage members discharged from the hospital is a staggering 30 percent. Fri, 20 Apr 2012 00:00:00 GMT. Default Censeo Launches CKD Evaluation Module An estimated 26 million adult Americans have chronic kidney disease (CKD) and many millions more are at increased risk of having this disorder. Anyone with high blood pressure, diabetes, or a family history of kidney disease is at increased risk for CKD.[1] Persistent protein in the urine is evidence for CKD. The symptoms of CKD are non-specific and hence early detection depends upon having a high index of suspicion and on screening those at highest risk. Mon, 16 Apr 2012 00:00:00 GMT. Default 492 Feet, Trig & Tom Boswell Washington National’s outfield, Jayson Werth, smashed a huge homerun a week ago Sunday. The ball cleared three sets of fences at Space Coast Stadium in Florida and landed in the players’ parking lot. Werth joked that it hit his own truck. The hit alone is impressive but the guy I also respect is Tom Boswell, the Washington Post columnist who decided to measure the parking lot, find a witness to confirm the ball’s landing point, and use a little trigonometry to calculate the ball was hit 492 feet. Tue, 10 Apr 2012 00:00:00 GMT. Default Got Gaps? It is still HEDIS season and some of you have launched your member evaluation programs, so your members’ gaps in care are surfacing. Rather than treading water, you need a systematic integration of all patients with care gaps, a monitoring process, plus a member and community physician outreach and engagement solution. Mon, 19 Mar 2012 00:00:00 GMT.