Risk Adjustment

Maximize Risk Scores Through Multi-Channel Member

Risk Adjustment Optimization Challenges

While the risk adjustment program was created as a safety net for payers, at times it often has an adverse effect on the payers it was meant to protect.
Newer and smaller payers are at a disadvantage due to their lack of member data and the limited resources to gather, analyze and utilize such data.

Without a systematic engagement system in place, payers are at risk of underreporting population Risk Scores.

Common Problems Facing Carriers

  • Current methods of outreach are insufficient to maximize the collection of Health Risk Assessments (HRAs)
  • Variable enrollment timelines and Special Enrollment Periods may result in greater challenges in gathering a members detailed medical history
  • Disengaged members are less inclined to proactively utilize preventative benefits, potentially resulting in compromised risk scores
  • Smaller and newer payers are less likely to have the resources required to directly engage their member population

Benefits of a Personalized Risk Optimization Strategy

  • Maximizing the collection of HRAs
  • Penetrate populations that are often difficult to access
  • Ability to gather detailed member analytics
  • Ability to expeditiously engage new member populations

Solutions for Risk Adjustment Optimization

VistaBPO has developed a comprehensive, personalized and cost effective approach to Risk Adjustment optimization.

We deliver support tools and strategies designed exclusively for the payer market.

By maximizing the collection of HRAs and the ability to reach often difficult populations, payers are able to maximize the collection of diagnosis codes, leading to optimized risk scoring.

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