Recently, the Department of Health and Human Services (HHS) released the summary report on Individuals and Small Group Market Risk Adjustment Transfers for the 2023 Benefit Year. The report offers a detailed overview of risk adjustment transfer payments by state, issuer, and plan, while also analyzing the key factors driving these transfers. It provides insights into the evolving dynamics of the Affordable Care Act (ACA) Marketplace.
At Ensure Data Solutions (EDS), we recognize the challenges that come with navigating and interpreting extensive healthcare data, especially in the context of:
- Complexity: Analyzing complex datasets and identifying meaningful year-over-year trends can be daunting, particularly when multiple variables are involved.
- Understanding Risk Adjustment: Fully grasping the intricacies of risk adjustment calculations and their impact on transfer payments.
Effectively managing the ACA patient population requires strong physician-patient engagement. EDS provides tailored tools to track risk-adjusted members’ progress, enhance patient engagement, and improve health management and clinical documentation. Additionally, our tools help with risk adjustment model computations and assess exposure through risk corridor reconciliations.
How We Can Help:
EnsureRS© Module:
- Track both documented and undocumented clinical conditions for suspected cases.
- Re-document clinical conditions from previous periods for existing patients.
- Predict risk scores before all coding information is accepted by regulatory agencies.
- Forecast risk scores based on suspected but un-coded and undocumented conditions.
ENSURECM© Module:
- Support population health management outcomes through automated notifications (email/SMS) for various clinical interventions.
- Track patient engagement by leveraging electronic medical record (EMR) care events via FHIR connectivity.
ENSUREQUAL© Module:
- Ability for PCPs to conduct SNP HRA surveys and improve SNP Care Management Star measure results.
Contact us today to learn more about how Ensure Data Solutions can help you optimize your risk adjustment strategy and improve patient outcomes.
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