Hospital Readmissions in Medicare Advantage and Medicare's Traditional Fee-for-Service Program
This report is the first publication based on a collaborative research program between MedAssurant, Inc. and America’s Health Insurance Plans (AHIP). Using methods comparable to those used by Jencks and collaborators (New England Journal of Medicine, April 2, 2009) on pooled, de-identified data from 2006-2008 from the Medicare Advantage (MA) plans in MedAssurant’s Medical Outcomes for Research on Economics and Effectiveness research database (the MORE2 Registry™), we find an unadjusted 30-day hospital readmission rate in the MA sample of 14.5 percent – about 25 percent less than FFS.
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Impact of RADV – An Update & Insight Into Strategic Priorities
CMS has signaled plans to materially expand the scope and potential financial implications of risk adjustment audit processes. In so doing, CMS has ushered in a new era of heightened focus on practitioner coding accuracy, quality controls on risk-adjusted data submissions, and preparedness for response to regulatory audits within Medicare Advantage and Managed Medicaid health plans. MedAssurant has been assisting clients to prepare for RADV audits, and has gained important insight from that experience. This case study considers the things that health plans can do to prepare for, and maximize the likelihood of a good outcome from, a RADV audit.
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Beyond “Clinically Enriched Administrative Data”: Using Patient-Specific Datasets to Drive Rapid Clinical & Financial Improvements
There is growing enthusiasm that the addition of clinical data – laboratory results and pharmacy prescriptions – to medical claims data will enable more effective patient management, and open a broader window on the performance of physicians and health care institutions. But these clinically enriched administrative datasets remain, at their core, administrative datasets. Rapid and profound improvements in clinical and financial performance in health care require a more comprehensive dataset – one that is truly clinically enriched through the targeted aggregation and assimilation of the relevant components of the patient’s broader healthcare picture.
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A Data-Driven Approach: Improving Outcomes and Financial Performance
Utilizing a patient data superset strategy of expanded medical data accuracy, comprehensiveness, granularity, and accessibility to drive real improvements in patient care management, utilization, and financial performance.
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Medicare Advantage Risk Adjustment
A meta-analysis of more than 1,000,000 Medicare Advantage member cases aimed at identifying causes for incomplete claims documentation and deriving comprehensive methodologies for achieving highly accurate claims documentation, optimized risk adjustment factors, and reporting for Medicare Advantage plans.
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