By RaeAnn Grossman
What does your risk adjustment team need to think about from application time to bid season?
Answers include but are not limited to:
- Are we changing our formulary and will this impact Rx risk adjustment?
- Are we narrowing our provider networks and will this impact campaigns or waves?
- Are we capitating more provider groups?
- What is the revenue target finance is baking into the bid for risk adjustment/premium accuracy impacts?
- How quickly is finance wanting to get premium impact?
- Are we adding any products that will increase dual enrollment?
A risk adjustment team needs to understand benefit design changes, formulary changes, provider relationship demands, and any system changes coming into play for 2018. These may directly or indirectly impact risk adjustment strategies.
Remember start early and run multiple waves to ensure your premium impact is being pushed into your benefits for care and that care needs are being met.
Care and medical record retrieval projects take 12-16 weeks. Make sure you have your plan and your targets laid out appropriately now.
Listed under: ArroHealth