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Member Health Analytics Insights for Risk Adjustment and Quality Programs

Data strategies to identify target populations and launch targeted interventions

Health plans use analytics tools to determine gaps in care and member documentation, whether related to risk adjustment objectives (RAF scores, HCC recapture) or quality measures (numerator, denominator.)

Both risk adjustment and quality teams have their own specific set of metrics they are tasked with to improve, and specific strategies that each tend to utilize to improve member outcomes. However, there is a bridge unifying both groups, and it is one in constant need of reconstruction in order to improve member interventions and outcomes. We are referring to member documentation.

This playbook aims to provide healthcare professionals and managers of risk adjustment and quality programs with data strategies to improve documentation — ultimately producing a more targeted approach to member interventions.

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider