As the health care industry moves away from volume towards value-based care, there has been a noticeable resurgence in the popularity of HMO managed care products which typically adopt capitation as a payment model.
Health care professionals need to understand that data submission incentives in managed care are different to fee-for-service (FFS). In a traditional FFS model, providers have a financial incentive to provide clean and timely claims data or they don’t get reimbursed. However under capitation providers are paid prospectively on a per member per month basis to undertake contractually designated services.
Consequently in managed care, payers need to take a more active role in monitoring and facilitating data submission from their provider network. Those plans without adequate resourcing or experience are likely to see data throughput and quality deteriorate, which could have profound financial consequences.
Whether you’re organization is gradually moving away from FFS or already experienced with capitation, healthcare leaders need to familiarize themselves with Encounter data and understand some of the data quality problems that can occur in managed care. This webinar will outline some of the challenges faced by health plans which lead to data gaps and TransUnion will provide best practice advice that your organization can take away to improve data operations.
By participating in this session, attendees will learn about:
Who should attend: The issues explored in this webinar will be of particular interest to health plans with HMO products.
Specific Job Titles: CIO; CFO; COO; Claims Manager; Claims Analyst; EDI Manager; EDI Analyst; Encounters System Analyst; Director of Data; Data Manager; Encounter Data Manager; Encounter Data Analyst; Chief Technology Officer; Director of Analytics; IT Project Manager; Business Process Management; Business Analyst; HEDIS Analyst; Director of Risk Adjustment; Risk Adjustment Analyst; VP IT, IT Director; IT Manager
Noelle Porter, VP Operations
Noelle has over 25 years’ experience in managing the data needs of some of the largest managed care health plans in the country. She has witnessed the evolution of Encounter data since the “HMOs” in the 90’s to the current emphasis on value based care. Today she advises and provides services around the data transmission and analytics of Encounter data, which continues to grow in importance in California and beyond.
Stephen Harrop, Business Analyst
Stephen joined TransUnion as a Business Analyst after previously working in the United Kingdom as a data quality analyst for the National Health Service. His role now involves raising awareness of TransUnion’s payer solutions nationally, particularly as the industry shifts towards managed care and Encounter data gains prominence.