The RISE conference, held in Nashville from March 17-19, brings together the best and the brightest from the world of risk adjustment to share best practices, learn from one another, and plan for the future—a future focused on achieving the triple aim of lower costs, healthier populations, and a better patient experience.
Of note, historically the majority of RISE attendees have been payers. This year there were quite a few medical groups in attendance, and the general consensus is that medical group representation will continue to grow in years to come. This suggests that provider groups are coming to understand the importance of risk adjustment and HCC Coding, and recognize that they need to address this challenge in a meaningful way.
Payer/provider collaboration was on display at RISE. Both parties benefit from accurate/appropriate HCC coding, so the incentive for cooperation is readily apparent. Within fee-for-service contracting, the relationship between payers and providers has historically been strained. Two examples of collaboration mentioned were 1) payers sponsoring investments in technology and services for the direct benefit of the provider group and 2) payers sharing their claims data with the medical groups.
There is no silver bullet to succeeding with risk adjustment, but listening to several presentations highlighted a few attributes shared by high-performing medical groups:
- First, they all have some variation on a ‘Pre-Visit’ planning process to notify providers of patients with chronic conditions (HCCs) they are likely to encounter on that day’s patient schedule.
- Secondly, they all recognize that providers are not coders. Providers cannot be asked to do more from a coding perspective.
- Thirdly, they have clear, concise reporting capabilities which are used to operationalize a coder to provider feedback process.
The sense of urgency within the industry to succeed within risk adjustment has increased significantly. In many cases risk adjustment contracts (as a percentage of overall revenue) are only increasing. At the end of the day, everybody in the industry is aligned on achieving the triple aim.
Learn more about HCC coding by watching our on-demand webinar: HCC Coding—Best Practices to Improve Capture Rates.
