UPMC Health Plan’s Risk Adjustment Transformation

  • June 07, 2016
  • 2:00 PM – 3:00 PM ET
  • Online
about

High Fidelity logo

Increasingly, reimbursement models are embracing pay for performance structures, where understanding the true health status of your membership is critical, thereby underscoring the importance of risk adjustment to plan success. Yet, health plans are making risk adjustment decisions using just 20% to 30% of available medical data which inevitably leads to inaccurate coding and unidentified risk.

Webinar participants will learn:

  • Explain the challenges UPMC Health Plan was facing in risk adjustment for Medicare Advantage and commercial/ACA populations.
  • Discuss how UPMC Health Plan addressed the challenges by applying Natural Language Processing (NLP) technology to risk adjustment process.
  • Review pre- and post-technology enabled coding workflow, NLP suggestions and analytics that transformed operations.
  • Share results which demonstrate:
    •  Substantial increase in RAF capture
    • Visibility into potential compliance issues/audit risks
    • 4x gain in coder productivity
    • Highlight key takeaways and lessons learned that can enable your organization to succeed in similar circumstances.
  • Highlight key takeaways and lessons learned that can enable your organization to succeed in similar circumstances.

Who should attend: Health Plans with lines of business that require HCC coding methodology for reimbursement. In particular, plans with Medicare Advantage or ACA Exchange members will benefit from attending. Individuals with responsibility for diagnosing, coding, and/or managing risk-based revenue.


Speakers:


Mary JenkinsMary Beth Jenkins, Senior Vice President & Chief Operating Officer, UPMC Health Plan

 

Adele TowersAdele L. Towers, MD MPH FACP, Senior Clinical Advisor, UPMC Enterprise

Participants Will Learn How To:

Higlight

Key takeaways and lessons learned that can enable your organization to succeed in similar circumstances.

Review

Pre- and post-technology enabled coding workflow, NLP suggestions and analytics that transformed operations.

Share

Results which demonstrate: visibility, 4x gain in coder productivity, and increase in RAF capture.