5 Questions to Ask Your Next Risk Adjustment Partner
[Editor’s note: this
blog was originally written by Steve Whitehurst]
As the availability of healthcare data continues to grow,
many new technologies for risk adjustment are entering the market. When
thinking about adopting a new risk adjustment solution, plans should conduct a
realistic self-evaluation in addition to also considering the support
capabilities and workflow expertise of their potential partners.
It’s important to understand your own risk adjustment
organization’s readiness in order to determine the best external approach for
your needs. In particular, a look at your overall performance, operations, and
infrastructure is vital to understand which partners will best fit your team’s
characteristics. You should have a full understanding of where your current
risk scores are, outstanding opportunities, staffing levels, data acquisition
processes, etc. to get a baseline of your overall maturity and sophistication.
A reputable partner will have expertise and processes to help with this step.
Once you have a good understanding of your status quo, it
will be easier to consider where outside support is warranted. Most vendors
love to pontificate on their solution, so we recommend you probe on their
support, industry expertise, and overall workflow adaptability in order to
ascertain their overall fit with your operations. Here are a five key areas to
1. What are
the improvement opportunities that are present in my organization? This
involves not only the quantification of risk capture potential, but also an
understanding of where in the risk adjustment ecosystem the opportunities
exist. This allows for meaningful prioritization of the opportunities.
2. What is
the best method of improvement to address these opportunities? Retrospective
review, prospective campaigns, provider education, billing staff education,
member outreach, etc. – depending on the type of opportunities that exist, the
appropriate method for improvement may vary. This is critical to maximizing the
3. Is my organization
ready to implement the proposed methods? If not, what are the gaps and how can
I close them? The best methods will not work if there aren’t enough coding
resources or if the appropriate data isn’t available. Together with the
solutions partner, the readiness gaps need to be addressed before moving
forward. A vendor with the best interest of the customer will not want to
implement a solution without a readiness check.
4. What is a
reasonable timeframe in which we can expect to see results? Organizations can
often have unrealistic expectations on how long the newly implemented solution
will take to demonstrate performance improvements. Establishing measurable
goals with specific timelines will help to attribute tangible ROI of the
solution for leadership while maintaining engagement from key stakeholders and
processes will be in place to ensure improvements are continuously sustained?
The biggest value of a technology-enabled solution is scalability. But if
implemented without sustainable processes, improvement gains will be
short-term, or your reliance on partner services will continue to incur costs.
It is essential that there is a sustainability strategy aligned with your
Technology is only as good as the user. In a world as
complex as risk adjustment, it is even more critical that technology solutions
are deployed to fit the specific needs of its stakeholders. When considering a
new solution, organizations should ensure that a potential partner’s people and
processes, in addition to the technology, are well-aligned with your strategy.