3 Strategies to Maximize Risk Adjustment for MSSP & ACO Reach

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models. Unfortunately, however, many ACOs that participate in MSSP and ACO REACH don’t have a risk adjustment program in place that’s set up for success—or they may not have one at all.

And without the right people, process and technology in place, it’s nearly impossible for ACOs to accurately assess the population’s disease burden, take informed steps to reduce it, and measure their progress in driving better outcomes. As a result, both new entrants and existing ACOs are challenged with understanding what it takes to holistically support a scalable risk adjustment program and, more urgently, where to start when bringing it to fruition.

Apixio is here to guide you on addressing these challenges and have leveraged our industry knowledge and years of risk adjustment success to comprise a list of strategies on what you need to maximize your risk adjustment scoring:

1. Leverage interoperability to capture data
Sourcing, gathering, and seamlessly accessing the siloed patient data that exists across multiple EHRs is key to the foundation of your organization’s risk adjustment program. NAACOS survey conducted this year, 39% of ACOs have more than 10 EHRs and only 17% have one EHR. However, many organizations lack the infrastructure and workflows to organize and efficiently aggregate this data, let alone use it to support their risk adjustment initiatives. However, by utilizing bi-directional interoperability across multiple EHRs, your organization will have one of the key building blocks with data access.

Pro tip: In order to begin capturing this data, your organization must first determine the current state of accessing data across EHRs.

2. Introduce prospective risk adjustment process to scale data
Once your organization is able to seamlessly and securely access data, the next step is leveraging this data to capture risk and drive patient outcomes. The optimal time to do this is to do so prospectively during pre-visit chart preparation. With 10-15 minutes of face time with each patient, clinicians have very little time to thoroughly review patient charts to fully capture risk at the point-of-care. However, with a prospective risk adjustment approach combined with AI-powered tools that allow clinical teams to surface actionable insights prior to the point-of-care, clinicians will be able to review charts faster, flag conditions for recapture and suspected, and help close care gaps to improve risk management and outcomes at scale.

Pro tip: Connect with your provider network and learn more about the stop-gaps and bottlenecks within their pre-visit workflow.

3. Improve HCC coding with an approach that looks both ways
Medicare ACOs are charged with maximizing value for their organizations while maintaining the highest coding accuracy standards. However, risk capture can be difficult to operationalize and scale, creating a huge administrative burden for providers due to the complex and time-consuming chart review process. By utilizing a proper coding, workflow, and auditing approach that is able to identify both missed coding opportunities and unsupported known codes, your team can have a complete and accurate view of the population’s disease burden.

Pro tip: Benchmark your population’s disease burden relative to your geography and evaluate how to identify the disease burden across your patients.

Risk adjustment success is attainable for your organization. And with the right steps, you can make this success a reality.

Contact us to learn more about how to bring these solutions to help support your risk adjustment program.

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