As the industry strives for data use that is standardized, consistent, and fluid, payers that automate data flow, in the long run, will be able to discern the risk of each member and prioritize their needs to drive member services for outcomes-based care delivery.
The greatest uncertainty is members' health status, which could impact MA organizations’ bidding submission process for 2022. Fortunately, fully vaccinated members are likely to resume in-person care this year, which means MA plans can expect a more consistent and reliable stream of data to form financial projections.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
When CMS approved telehealth as a means for health plans to gather risk adjustment data it made the right move, as it is critical for Medicare Advantage (MA) plans to stay on track with risk adjustment.
The appeals court overturned a New Mexico court’s ruling that the risk adjustment approach was “arbitrary and capricious.”
Sutter Health was allegedly involved in a practice called upcoding, which refers to the submission of incorrect or exaggerated information about the health status of a beneficiary in order to receive a higher payout from CMS.
The report from the Inspector General comes amid increasing scrutiny of Medicare Advantage organizations for potentially overcharging the government for services.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.