by Luke Shulman

RISE Nashville

I recently returned from the amazing RISE Association Risk Adjustment Conference. In my experience, there are two types of conferences. Puff conferences that are designed to be congratulatory to the sponsors/exhibitors and the participants. Puff conferences are filled with congratulatory sessions that are a hodgepodge tales and stories from the field wrapped in the veneer education credits. Then there are conferences where people have to learn something and are getting to work and sessions are largely lead by experts.

RISE Risk Adjustment was the latter. At each session, the speaker would ask for a show of hands of people who had worked with in Risk adjustment before and there were a lot of first timers. Then the session would quickly throw them into the deepens covering things like the complicated timing of HOS surveys used in STARS to correcting your submissions in RAPS sweeps.

The GOP proposed American Health Care Act (AHCA) dropped on the first day of the conference and one speaker, who had been scheduled to discuss the new administrations proposal threw her slides out and remade her presentation overnight. The result was incredibly detailed thoughtful analysis that everyone was grateful for. (Follow @KristaDDrobac)

All in all it was a great conference here are my takeaways:

The Complex Web we Weave

I’ve worked in health analytics for almost 10 years. In risk adjustment, I’ve parse the hierarchies and ICD codes in the various models across HCC, DxCG etc. I’ve parse the MMR and the RAPS returns. But, I still failed to realize the scope and scale of health plan efforts to ensure the coding for risk adjustment. (I won’t comment on whether every plan respects the principle that they need to both ways adding codes where appropriate and also removing codes where inappropriate.) One MA plan on the west coast has a provider liaison visit every in-network primary care office weekly to review coding and STARS scores. (Tip from that plan: Bring donuts and coffee for staff).

There has been a lot of conversation among health systems about creating the “hospital at home”. Well, its actually being driven fiercely by the health plan as they deploy armies of providers (including NPs, and Doctors) into the home on visits ranging from 60 to 90 min. One large health plan in the southeast listed 10 different vendors in their presentation that were helping to coordinate the RISK and STARS capture for their plan.

Even though i consider myself a industry junior veteran, I failed to understand the scope and scale of this operation.

Do More with Less

Some of the most innovative and dynamic programs and results were presented by smaller health plans who have used their smaller size to drive and incredibly personal approach to their members. This may be a self-selecting group as it’s easier for one person at a small organization to pull together conference materials than it would be a national player where hundreds of people are supporting a program. Still, I was really impressed by the analysis and intervention these small plans had done. As in the above tweet, “Everything is local”

At a small plan in the southeast, their VP of Managed Care described her teams as the “queens of excel”. They deploy and customize multiple predictive models that incorporate many of the proven academic assessments that are predictive hospital admissions, fall risks and medication usage. They use group on-boarding session for new members where the participants begin to recommend to each other providers that have appointment availability even imploring members to stay up to date on screenings. They have even found that certain CAHPS measures are leading indicators to certain HEDIS measures giving them early indication of how they will do on some of the access related HEDIS measures.

Definitely no Consolidation

From the plans that presented, none of them were using one platform or one vendor for anything. Everyone seem to have a patchwork of home grown systems or multiple vendors. It is too simplistic to say that groups are adopting a “best of breed approach”. Rather, its more that the complexity demands a wide range of resources and different approaches. A certain segment of membership requires highly coordinated high touch care. Also, the potential value of some of these programs by earning revenue through risk adjustment coding or quality improvement is high enough that the coordination of data and services is less of a concern.

What was missing were tools that could help weave together the activities and at least allow for plan analysts to understand their effects. As one plan pointed out, “The XML feed from the in-home services comprises over 100 data points. We currently can only use 10.” new modular technologies should make it really easy to on-board and test new data to handle the variety.

Wrap Up

You can find all of our live coverage of the RISE Conference on Twitter LIVE COVERAGE FROM RISE.

What did you think of RISE? Let us know in the comments or on twitter @AlgorexHealth