CMS recently released results of the 2019 and 2022 RADV audits, to ensure that actuarial risk was reflected in transfers and that charges and payments were accurately assessed in 2019 and 2020. In the Summary Report on Data Validation Adjustments to 2019 and 2020 Risk Adjustment Transfers, CMS reinforced the importance of accurate illness burden documentation in determining accurate liability risk scores and risk adjustment transfers as many plans were required to pay out more than initially projected. Prospective risk adjustment solutions at the point of care make certain actuarial risk is as accurate as possible and creates greater clinical outcomes for patients.
How can Stellar Health help your organization?
Stellar works with health plans to drive outcomes that support risk adjustment at the point of care. Our platform engages the full care team to optimize value-based care workflow, leading to overall better performance, improved care delivery and more accurate illness burden documentation. Practices are rewarded with timely payment for time spent with patients to close care gaps, which drives behavior change and engagement. This increased engagement has been proven to quickly lead to a clear value-based outcome.
Stellar’s Focus Areas for driving performance and accuracy
- ACV Completion Rate – Increased annual care visit rates lead to code recapture, quality improvement and total COC reduction
- Quality Performance – Increased performance on High Blood Pressure, Breast Cancer Screening, and Colorectal Cancer Screening and other preventative screening measures
- Risk Adjustment Performance – Stellar utilizes claims data to surface undocumented diagnoses to give physicians greater insight into a patient’s clinical history
- Direct Incentives – Stellar puts dollars directly into the hands of care team members for driving VBC actions
- Care team Engagement and Enablement – Stellar engages all levels of the practice staff with an easy to use platform
In 2021, we improved a regional health plan’s recapture rate of historically documented chronic conditions by 8% YOY within their Medicare Advantage book of business. We work with practices and health plans of all shapes and sizes to empower PCPs to provide better care to patients and help health plans better document outcomes.
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