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Risk Adjustment

How many HCCs does it take?

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.

Risk Adjustment

Advance Notice 2020 Part 1

The recently released CMS Advance Notice 2020 Part 1 may not have many surprises in it, but there are a number of key components that will have far-reaching consequences for health plans. The April 2, 2018 final ruling foreshadowed many of the new changes by confirming that CMS will, in fact, have to implement the 21st Century Cures Act. That means that changes from reviewing and assessing the risk adjustment model will begin in 2019 with full effectuation in 2022 and beyond. In the immediate future, health plans will have to deal with some consequences that range from the good to the not-too-bad to the ugly.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – November 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Infographic

2018 ACA Enrollment by the Numbers Infographic

The Affordable Care Act (ACA) hits its eighth year in 2018. The program, designed to provide affordable health insurance to more American citizens, saw a decrease in enrollment from 2017. Let's dive into the numbers behind ACA enrollment in 2018.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – September 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Infographic

How Are Your STARS Ratings Measuring Up?

View an interactive infographic of plan performance for each of the different STARS measures.

News Roundup

News Roundup: October 2018 Edition

epi-Insiders: Read the October 2018 edition of our News Roundup.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – August 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

Risk Adjustment

Your NLP Solution is Only As Good As The Data You Give It.

The success of Natural Language Processing (NLP) solutions for healthcare require more than just a solid AI program behind them. NLP solutions require extensive domain expertise on the part of the programmers and coders creating the solution alongside complex machine learning algorithms. Additionally, underneath every good NLP engine is a good set of training data – a dataset put together to show the machine the right way to make connections between entries.

News Roundup

News Roundup: September 2018 Edition

epi-Insiders: Read the September 2018 edition of our News Roundup.

Medicare Advantage Updates

Medicare Advantage Enrollment Update – July 2018

Learn about the top organizations, biggest enrollment changes, and year-over-year growth

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