Improve Data Ownership to Fast-track Your Risk Adjustment Strategy
Analytics are the foundation for risk adjustment programs. So, how do you gain the critical performance insights you need without a deep understanding of the data? Especially when complete oversight requires a considerable time commitment. True data ownership is often a capacity and subject matter expertise issue, which can be overcome by efficient processes that provide vital visibility and transparency.
Through qualitative assessments, including desk reviews and interviews, we identified key areas you can examine when reviewing your analytic progress.
The value of your risk adjustment analytics
Using data and analytics to inform performance and strategies is essential for successful Medicare Advantage risk adjustment programs. And we know that predictive and descriptive analytics have direct member and organizational benefits.
The potential to slow disease progression and reduce complications lies in diagnosis identification. Member health status and awareness are substantially impacted. Targeting the right intervention at the right time for the right member is critical for member engagement and comprehensive data collection.
Gaining insights into performance allows the organization to correct course and understand the value-added components of existing strategies. Generating pertinent analytics to recognize the financial viability of the product portfolio, along with future projections, allows organizations to plan for future product offerings and enhance their program’s strategy.
Your need for transparency
Our research found that scalable processes seamlessly ingesting, cleaning, and enriching data offer organizations risk adjustment insights at the point of need. This optimal state promotes transparency in the analytic process, a common issue for clients with minimal input or control over the analytics developed solely by third parties.
Identification of your current state
Each organization’s optimal state may look different but must include the appropriate people, processes, and technologies. To achieve this, you’ll need to ensure you have the following in place:
- Data preparation procedures to create analytic-ready data for processing
- Subject matter expertise with analytic and institutional experience supporting risk adjustment programs
- Member-level analytics to generate informed risk adjustment strategies
Structure for your risk adjustment program success
Consider these options for structuring your data analytics program. The best depends on your organization’s budget, resources, expertise, and commitment.
- Build - Dedicate internal teams to the data curation and modeling efforts.
This approach creates an opportunity for flexible deployments and internal ownership, but development is often costly and timely.
- Partner - Contract with an external partner to provide risk adjustment analytics.
Partnering presents the opportunity to leverage best-in-class analytics in a timely delivery model, while data transparency isn’t always available.
- Hybrid - Leverage internal resources and external solutions to monitor risk adjustment performance and internally develop analytics.
This option is the best of both worlds because it empowers internal teams to use acquired skills while leveraging a partner’s scalability. Further, this option leaves the heavy lifting of data architecture, parser development, and model maintenance (all the activities necessary to get data to the point of analysis) to an external vendor so internal resources to focus 100% on analytics that will drive business performance.
- Do nothing - Avoid committing to a formal program
Monitoring performance is unavailable due to data integrity, lack of risk adjustment knowledge, or available resources.
Leverage the power of the Pareto Hub
Pareto has developed the Pareto Hub for organizations considering the build, partner, or hybrid option. This expertly curated data environment is strategically designed to support Medicare Advantage revenue management programs.
Our latest webinar includes an in-depth demo and robust Q&A session (including live queries) showing the versatility and capabilities of the Pareto Hub.
The webinar’s extensive demo reviewed actual Microsoft SQL logic and showcased the power of the solution, including:
- Querying ability and dashboards can be created and hosted within your environment
- Executive-level reporting, financial reporting, and risk reporting are available right out of the box
- Executive summaries offer a full view of membership, including product and membership mix
- Membership churn dashboard shows the movement of members year-to-year
- Member-level data drive risk adjustment activities throughout the year