Clinically Enhanced Risk: A Payer-Provider Partnership
February 22, 2017 — 11:30AM EST - 12:30PM EST
Orange County Convention Center
The transition from Fee for Service (FFS) to Fee for Value (FFV) is a difficult undertaking for both payers and providers, but it can be greatly improved with an enhanced relationship and collaboration between the two.
Western Connecticut Health Network (WCHN) and Aetna are engaging in this type of collaboration, but with a data asset that combines EHR and claims data, enabling the partners to apply resources and direction to best achieve the Triple Aim. Strong collaboration and the use of data to generate meaningful ROI is helping these organizations create new and innovative products, allowing for a financially prudent way for providers to transition from FFS to FFV. Rowena Bergmans, VP of Clinical Integration and Population Health, and Dan Dyer, General Manager Medicare, New England, will discuss how they identified a 12.3% improvement in premiums for Medicare Advantage members and share a roadmap for those who want a better way to understand, manage and document patient risk.
Apply lessons learned from this strong, data-focused payer-provider collaboration to improve attendee’s own payer-provider relationships
Define the six key types of data capture gaps that can impact risk adjustment
Choose an appropriate intervention approach to close different types of prospective data capture gaps at the point of care
Formulate a plan to close retrospective data capture gaps that directly impact risk-adjusted premiums for a prior plan year