Moving Risk Adjustment Upstream for
Better Care Plans and Revenue Capture

 

A Panel Discussion with Payers and Providers

Rebecca Welling

RHIT, CCS-P

Director of Coding Compliance

Dr. Adele Towers

MPH, FACP, CRC

Director of Risk Adjustment

Dr. Darcie Robran-Marquez

MBA, CPE, CRC

Executive Medical Director of Population Health

Overview


Together, these panelists cover their own paths to successfully integrating risk adjustment strategy into workflows that positively impacted patient outcomes.

They discuss their own approaches to financial integrity and the value of compliance, and how NLP and analytics technology amplified their clinical care efforts.

Finally, they discuss how they, as providers and payer organizations, collaborate for mutual sustainable success. 

Key Takeaways


  • Risk capture is moving into provider workflows before, during, and after the clinical encounter impacting patient outcomes, clinical resource utilization, financial integrity, and compliance.
  • NLP and analytics tools are amplifying the impact of clinical and revenue cycle staff, improving an organization's capacity to provide a higher quality of care while realizing appropriate care funding. 
  • Careful consideration of HIT readiness, process alignment, population growth, and physician support is required to determine the optimal starting point and sequence of solution deployments for organizational success.

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