Peer Perspective: UPMC Case Study

Mary Beth Jenkins, SVP & COO at UPMC HEALTH PLAN and Dr. Adele Towers, MPH at UPMC Enterprises will explain the challenges their plan was facing in risk adjustment for their MA and Exchange populations. Together, they'll discuss how they overcame several challenges and improved plan performance.

Leave with key takeaways and lessons learned that will enable your organization to succeed in similar circumstances.

Webinar Highlights

• How UPMC Health Plan addressed their MA and ACA challenges with Natural Language Processing (NLP) technology
  
• Pre- and post-technology enabled coding workflow comparisons, NLP parsing example and data ingestion process that transformed risk adjustment operations
• Health plan results, including:
  • Substantial increase in RAF capture
  • Visibility into potential compliance issues/audit risks
  • 4X gain in coder productivity

Key Takeaways:

• Risk adjustment barriers often coincide with barriers to care
• A good risk adjustment strategy supports population health
• Adoption of risk and associated workflows support clinical documentation and vice versa
• Supporting care initiatives after adopting risk with a strong, reliable ROI

Opportunities, New Challenges, and the Lessons of Success

The move toward value-based care – and, therefore, risk sharing among provider and payer organizations – continues to gain steam. As such, more provider organizations than ever before are participating in risk sharing contracts, but success hinges on their ability to manage and adjust risk.

Risk is often seen as an administrative element of healthcare, separate from clinical work. However, recognizing risk as the pebble in the shoe of an organization on a journey to provide care long into the future is a critical step. This white paper, using real world examples, shows how prudently managing risk supports clinical care through a well-deployed risk adjustment strategy both organizationally and financially.