Risk adjustment plays a critical role in the healthcare industry, allowing Payers to provide high-quality care to their members and drive plan profitability by accurately estimating medical costs. However, the current process can be time-consuming, resource-intensive, and potentially impact the quality-of-care members receive. As mentioned during our recent webinar, in order to resolve these challenges, payers can leverage a centralized data platform with FHIR APIs to greatly improve HCC data integration and data normalization. By leveraging advanced analytics, in combination with comprehensive, normalized, electronic medical record (EMR) data and claims data, payers can move toward real-time risk adjustment modeling.
As someone who has utilized both traditional and automated risk coding methods, Health Chain CEO and Founder, Sudheen Kumar emphasized during the webinar how much more efficient and accurate automated risk coding is. With access to technology that identifies and combines ICD-10s with clinical keywords from unstructured or poorly formatted data, Payers can streamline the coding process, with resulting benefits of better member care and better plan economics.