Medicare Advantage Revenue Management
Providers and payers serving Medicare patients face huge challenges. Future success will require more than just relying on revenue enhancement strategies. Success demands an integrated approach to risk adjustment, cost containment and quality improvement; designing health risk assessment models that link diagnosis to treatment, and pursuing quality improvement strategies that positively impact clinical processes.
Risk adjustment models continue to evolve with different HCC versions plus the migration to EDS data as the basis for risk model calibration. Mile High helps clients keep up to date with these changes and understand the impacts to their risk adjustment programs. For example, we actively model client risk score impacts of migrating to EDS, assess impacts of data filtering which will now be done by CMS instead by the plans, and target members and providers for risk score interventions.
Similarly, CMS is continually modifying the rules of the game for quality ratings as they gain more insight on which measures drive the most positive consequences. Mile High Healthcare Consulting tracks these changes closely and helps clients measure impacts to their quality scores and quality improvement strategies.
Medicare Advantage Support
We help clients navigate the changing Medicare Advantage landscape with: