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After payment model changes are applied, risk scores are likely to decline without supplement. We review the changes to see precisely what the new HCCs and updated normalization factor will do to RAF.

It’s time to limber up so you don’t get lost in the upcoming HCC model melee. On April 1st, CMS released the 2020 final call letter, confirming what models will be used moving forward and deciding the direction of MA for the immediate future. Read how to best prepare for the changes.

NCQA issued important changes in order to increase the consistency and reliability of HEDIS data submissions. The new requirements will change HEDIS reporting for all health plans, but could be significantly more time consuming and costly for some. Here's what you need to know.

When it comes to creating a care gap closure program, there’s no one-size-fits-all approach. A wide range of strategies and tactics can help, but by looking at your data, using predictive analytics, and creating personalized campaigns, it is possible to close care gaps before 2020.

The time has come for the PCC/APC models to start being implemented, changing the way populations and their scores shape up. With the PCC model now including the additive risk scores for the condition count, CMS has decreased many of the individual HCC risk scores used in the current model—for instance diabetes will see a 14% decrease, with reductions counterbalanced by an increase in other risk scores. The change led us to do a statistical analysis that assessed the impact of these substantial changes.