Advantmed’s Post

Are you prepared for how regulatory changes and evolving risk models will affect your health plan’s #ROI? Join us on August 6 at 1:30 pm EST for an insightful webinar hosted by Jimmy Liu in partnership with #RISE. Don’t miss this opportunity and Reserve your spot here: [Why Succeeding at Medicare Risk Adjustment is Now Harder Than Ever](https://lnkd.in/ebnEj9GQ) #Healthcare #RiskAdjustment #Webinar #Medicare

Mastering Medicare Advantage risk adjustment requires a holistic approach that blends detailed data analysis, robust documentation practices, advanced IT systems, and strategic provider engagement. MA plans can ensure accurate diagnosis capture, improve documentation compliance, and optimize risk adjustment outcomes by focusing on these areas. The cornerstone of this process is creating a digital twin for each member, which provides a comprehensive and accurate representation of their health status and needs. This innovative approach enhances the risk adjustment process and improves care and outcomes for Medicare beneficiaries.

There's tons of buzz in the risk adjustment world about AI, Machine Learning, NLP, (insert buzzword here... the blockchain is probably involved somehow too) etc. models that seek to find potentially missed HCCs within your population. These models can be pretty cool, but we've found that before health plans invest a ton in fancy suspecting algorithms, they can often get a much bigger ROI from just using the data they have in front of them: if someone had a chronic condition last year, they probably still have it this year, and something as rudimentary as an XLOOKUP in an Excel sheet can find these opportunities. You can always count on the folks at Wakely to bring brilliant insights about the ACA market and risk adjustment - they've got unparalleled relationships within the ACA market that gives them a unique view into the challenges and opportunities. This paper found that the plans who were better at recapturing HCCs year over year saw a $20 PMPM improvement vs those plans who were not as proficient at recapturing HCCs - for a plan with just 10,000 members, that's over $2M a year in opportunity. What are you doing to maximize these opportunities right in front of you?

The publication of the 2025 CMS Final Rule reveals that succeeding in #MedicareAdvantage will require health plans to think differently about member acquisition, retention, risk adjustment, MLR, and Star Ratings. Learn more about the 5 key updates that health plans need to consider to stay compliant and competitive: https://lnkd.in/gYddkw-k #MA #CMSFinalRule #Healthcareinnovation

#MedicareAdvantage plans are taking hit after hit with all of the CMS changes this year and in the years to come. Get ahead of the curve with insights from a panel of Star Rating experts in our upcoming webinar Ask the Experts: Tackling CMS Changes for 2024, 2025, and Beyond. Register Now: https://hubs.la/Q02rSHdY0 Join Hayley Rogers, Consulting Actuary for Milliman, and Samantha Cordero, Wellth’s Chief Customer Officer, to get the latest #StarRatings insights and ask questions regarding what your health plan can do to avoid massive losses in the future.

New Research offers actuarial guidance and a model for Medicaid and CHIP managed care capitation rate setting. Use the report and Excel model to develop the underwriting margin component of capitation rates: https://bit.ly/4cVGazh. #actuaries #actuaryresearch

On Debate Night in America, many things are uncertain — but one fact is crystal clear: dialysis claims are high-cost, volatile, and can wreak havoc on self-funded plans… Specialty Care Management's risk management programs, including fixed, capitated, all-fees-inclusive case rates, help turn unpredictable, high-cost claims into manageable, predictable expenses for self-funded health plans —all with ZERO implementation, a la carte, or % of savings fees. There's no debating the impact of our solutions for enrolled plans: ✅ 58% in additional savings over traditional network solutions ✅ Free data analytics to identify pre-dialysis claimants ✅ Industry-leading CKD management programs to improve member health and reduce costs. Let’s get to work. Learn more with a complimentary discovery call: https://lnkd.in/eyXj8mps #SpecialtyCM #RenalDialysis #CostContainment

Addressing preventable denials can reduce collection costs and improve financial health through accelerated cash flow. Learn how to establish a denial prevention function in the latest BDO Knows Healthcare blog post. https://bdo-usa.co/3WqZQ8i

Addressing preventable denials can reduce collection costs and improve financial health through accelerated cash flow. Learn how to establish a denial prevention function in the latest BDO Knows Healthcare blog post. https://bdo-usa.co/3YeDLuO

Addressing preventable denials can reduce collection costs and improve financial health through accelerated cash flow. Learn how to establish a denial prevention function in the latest BDO Knows Healthcare blog post. https://bdo-usa.co/3zLZzUz