GlobalHealth: Leveraging Predictive HCC Risk Adjustment Analytics to Reduce Medical Loss Ratio (MLR)

Uncover the Hidden Savings Opportunities

HCC Risk adjustment is one of the top untapped opportunities for an HMO or Provider group taking on risk with Medicare, Medicaid, or dual-eligible contracts. Accurate HCC coding information helps create a more complete picture of the complexity of a patient population and enables better management of a patients’ chronic diseases.

View this webinar with Carey B. Ketelsen, Executive Director at Global Health, and Jay Reddy, CEO of VitreosHealth as they look at the importance of understanding and measuring risk related to value-based care contracts – Medicare Advantage, Medicaid, and Dual-eligible populations.

Carey Ketelsen will discuss how GlobalHealth has transformed its HCC Risk Adjustment process from its traditional fragmented process to a technology-enabled process utilizing advanced predictive analytics. During this webinar you will learn:

  • How their traditional manual intensive process resulted in challenges, limitations and lost opportunities;
  • That their new process leverages multiple data sets including medical claims, pharmacy claims, EMR data, HRAs and external socioeconomic data to create a 360-degree risk profile of the member;
  • How they identify under coding opportunities through workflow-enabled advanced analytics;
  • How GlobalHealth proactively identifies gaps-in-care and any associated coding gaps leveraging disease specific predictive models;
  • How through this process they are now able to accurately forecast revenues;
  • What future plans they have with respect to RAPS submission, ICD-10 and preparing for EDS.

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