Data integrity is critical
It’s the age-old balancing act. Health care organizations have a finite number of dollars to spend across competing priorities while being under continuous pressure to reduce costs, improve health care quality and ensure all applicable regulatory requirements are satisfied.
For risk-adjusted populations, it’s important to consider how complete and accurate reporting of your health plan’s membership plays a role in this equation.
Most health plans are continuously implementing new or modifying existing cost-saving measures across almost every department. These initiatives may include medical management reviews, narrow networks or other targeted operational strategies. For risk adjustment, reducing costs may include cross-training teams to work on multiple lines of business or employing targeted analytics for certain programs like chart review.
We generally see risk adjustment programs advance as a health plan matures. For example, new health plan entrants may focus on retrospective chart reviews, while those that have been in the market longer often add in-office and in-home assessments. Whether the emphasis is on retrospective, prospective or a combination of both programs, the goal is to ensure accurate, complete and timely reporting of data.
Many plans have realized the impact of data integrity. Optum has found that incomplete encounter data accounts for a revenue loss of up to $63 per member per year.*
Encounter data quality is not only important for accurate and complete reporting; it can also help reduce costs, improve quality scores and have a positive impact on health care outcomes.