With six different models across the various States, caps on cross-competitor premium increases, and restrictions on supplemental data, Medicaid is by far the trickiest, but, at Pulse8, we live for such challenges
San Diego, CA (PRWEB) May 20, 2017
In its 10th year, the annual RISE Risk Adjustment Forum focuses on content-driven topics and convenes top industry experts with years of experience and proven results in risk adjustment.
During this presentation, attendees will get a better understanding of Medicaid Risk Adjustment, including the following:
- The differences in Risk Adjustment between Medicaid, Medicare Advantage, and ACA Commercial
- The various Medicaid Risk Adjustment models and what states use them
- Deep dive into the most commonly used model in Medicaid
- Challenges that are especially acute in risk adjustment for Medicaid, such as primacy of the claim
- Analytic capabilities needed by risk-bearing entities to obtain the best results in their Medicaid programs
“Each of the three risk-adjusted government lines of business – Medicaid, Medicare Advantage, and ACA Commercial – has its own unique model and market factors,” remarked Mr. Stratton. “The Product Team at Pulse8 is comprised of experts for each segment, who have collaborated to deploy the most advanced clinical inferencing rules, risk adjustment algorithms, and quality measures specific to each market. With six different models across the various States, caps on cross-competitor premium increases, and restrictions on supplemental data, Medicaid is by far the trickiest, but, at Pulse8, we live for such challenges.”
Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment and Quality Management programs. We enable health plans and at-risk providers to achieve the greatest financial impact in the ACA Commercial, Medicare Advantage, and Medicaid markets. By combining advanced analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment and quality. Pulse8’s flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information, please contact Scott Filiault at (732) 570-9095 or scott.filiault(at)pulse8(dot)com. Please visit us at http://www.Pulse8.com, and follow us on Twitter @Pulse8News.
About RISE (Resource Initiative and Society for Education)
RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development.