providerengagementwaynepanmdpreedaroreggiomd

agenda• why?• how?• getting their attention• who to involve?• when to start?• what's at risk?• follow up• q&a

why?• can you effectively manage a

Medicare risk adjustment program without provider engagement?

• yes, but it involves building a network of providers who can review and document the work that providers are doing - redundant and expensive

why?• can you effectively manage a

Medicare risk adjustment program without provider engagement?

• no, because provider documentation is the foundation of risk adjustment and provider engagement is essential

how?• set clear expectations• establish mutual goals• data, data, data

• timely• quantifiable• changeable

• education

incentiveprograms• nothing is free

• fee-for-service model - pay for services performed

• annual refresh examination and documentation

• providing charts for documentation auditing

incentiveprograms• capitation model

• annual HCC bonus based on

• benchmarks for process

• benchmarks for risk scores

who?• which physicians: PCPs vs

specialists vs hospitalists?

• office staff

• member services

• nurse case managers

when?• timing is everything

• cms data reporting schedule: sweeps

what's@risk?• under reporting

• under documentation (over reporting)

followup• close the loop

• how is provider efficacy communicated?

• progress reports (static)

• provider dashboards ("real-time")

• how well is your program working: benchmarks?

benchmarks• compare to last year

• % chronic hcc's rolled-over

• % patients with annual hcc refresh visit

• % of algorithm identified "suspect" codes captured

• is there a true hcc benchmark?

?

thankyou