HCC Optimizer Streamlines Risk Adjustment
Industry Challenge: The HCC Coding Problem
Risk adjustment is the process of determining a patient's health status to predict cost of care during a specific time period. The Medicare Advantage (MA) program uses risk adjustment methodology to set annual capitated payment rates to contracted health plans based on a Hierarchical Condition Category (HCC) model called CMS-HCC. Payment from the Medicare Advantage program to Health Plans increases...
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Big Data Reveals Crucial Hidden Information in Healthcare Systems
Health Technology Use Case
Technology leaders in healthcare know that managing risk for a population requires a highly informed, data-driven approach to tracking the care of patients. The challenge is that coded data from administrative sources falls far short of faithfully representing the clinical history of a patient. Studies show that more than...