Navigating a Successful Shift to Value-Based Care
Whitepaper Jul 02, 2021
When results are essential and time-sensitive, you trust the experts. Tegria can help payers understand and prepare for critical regulatory changes, such as the 2024 changes to the Hierarchical Condition Categories (HCC) and Risk Adjustment Data Validation (RADV) guidelines.
With deep experience working with payer and provider organizations, we know which questions to ask and how to collaborate with key stakeholders to ensure your organization is ready for January 1, 2024.
Tegria’s analytics services can help quantify the impact of the 2024 HCC changes on your specific population and business model. We can help you understand the effects on the total number of payable HCCs, Risk Adjustment Factor (RAF) scores, and percentage change from the previous HCC model to the 2024 model. Our analytics insights can also identify business-critical areas to focus on, such as specific provider groups, disease categories, and more. In addition to providing customized analysis of the HCC model impact, our services can help you estimate future recoupment costs due to the announced RADV audit changes to help proactively manage the effects of OIG findings.
We know that each organization is different. Some organizations may experience minor impacts, while others may need more significant interventions or additional resources to mitigate future repercussions. Tegria can help evaluate your operations to assess vulnerabilities and provide a plan and guidance to help you implement changes. Tegria can work with your team to incorporate the impact of coding guideline changes into your strategic planning and business strategy, including identifying opportunities for cost savings to ensure your organization is financially healthy for the long term.
HCC changes will impact coding and risk adjustment workflows across various areas of your organization. To prepare for the changes, organizations must assess workflows, policies, and procedures to identify required changes. Payers should also conduct an internal training assessment to determine which resources should participate in updated training. Tegria can help with workflow impact analysis, updates, training materials, and execution.
Close collaboration with your provider partners will be more important than ever with the upcoming regulation changes. Tegria can help you identify and prioritize provider groups where offering education and training support on HCC changes is mutually beneficial. Tegria’s training materials are created and delivered by clinical experts who understand the needs of your organization and provider partners. In addition to provider education, interoperability with provider partners can help improve Risk Adjustment workflows and accuracy. Tegria can help evaluate your organization’s interoperability capabilities and leverage our experience to identify opportunities for strategic improvement to address critical business needs.
Wherever you are on your journey, Tegria can help. Whether you’re just learning about 2024 changes, ready to update workflows, or somewhere in between, we meet you where you are to help quantify the impact on your organization, incorporate the effects into your strategic planning, and improve operational and provider readiness.