There isn’t a single “right” path when it comes to improving member care and medical condition documentation. There are no shortcuts either.
As the market continues to evolve, health plans face mounting pressure to improve quality and keep costs down. However, a properly executed, multifaceted provider engagement program can lay the foundation for risk-score accuracy, Star Ratings and more.
Successful provider engagement programs include at least four key elements:
Such programs work best when physician practices are assigned dedicated representatives who take the time to understand existing workflows and develop meaningful relationships with providers and other practice personnel.
It’s all about promoting effective physician-patient interactions. For example, representatives might deliver prospective gaps ahead of patient visits to ensure any chronic conditions are captured accurately.
Of course, health plans would be wise not to confuse a high touch with a heavy hand. While
representatives can arm physicians with the information they need to improve medical record documentation, they should not direct physicians to specific conditions.
Done right, provider engagement programs help plans improve member health management, documentation quality, risk score accuracy and Star Ratings, while increasing compliance with CMS guidelines and reducing audit risk.
In the spring of 2018, Tessellate integrated with a sister company to form a stronger, more competitive organization, with the ability to leverage complimentary products and services and deep industry expertise. Recently, the company unveiled its new brand, Advantasure, with the tagline: Fueling Accelerated Performance.
The new name and tagline accurately reflect the company’s unique suite of technology products and business process services that improve the performance of health plans and provider organizations in the delivery of government healthcare programs.