RISE Industry Collaboration on RAPS to EDS

August 18:  Today we broadcasted a webinar that presented the RISE Industry Collaboration on the Medicare Advantage migration from a RAPS-based method over to an encounter data system (EDS) for creating the Risk Adjustment Factor (RAF Score) beginning in 2016. This collaboration is an industry-wide effort to gage the effect of switching to an EDS method and how that impacts the CMS premium levels for MAOs.  Inovalon has offered to serve as the technology partner supporting this analysis, and our presentation today walks the audience through the purpose and methodology proposed.  We aim to identify MAOs that want to participate by August 31 so we can commit the resources to conducting and completing the study by the end of December this year.  


Download flyer:  RISE RAPS EDS Collaboration

Plans that wish to participate will contribute their membership weight to achieving the critical mass to make this study meaningful and useful. That will be important to all of us, but in particular if we wish to present anything of value to CMS, who have voiced some potential interest in the collaboration. The deliverables will not only be benchmarks at the aggregate level to compare your own results, but depending on the scale of membership in the study, further slices can be provided.  Ultimately, there will be the ability to discern even more insights at the diagnosis level, for example.  See the chart below from the presentation.


Description of Contents

  • Data Evaluation and Filtration

The use of two independent systems for RAPS and EDS allows the application of

 submission rules and filtration logic to analyze the data that are valid for submission for a DOS


  • Risk Factor Analysis and Reconciliation

Provided analysis and discrepancy reporting between EDS and RAPS and

risk score analysis insight into the plan-level and contract level.

  • Disease Prevalence Analysis and Reporting (plan-specific and optional)

Analysis of the disease and co-morbidity status at the cohort and sub-cohort

levels  within the context of a DOS period in order to evaluate the current and

potential disease status of the membership for benchmarking purposes.

If you were unable to participate in the webinar today, please follow this link to view and hear the webinar on your browser:  RISE/ Inovalon Industry Collaboration on RAPS / EDS Migration   

Your password for accessing the webinar is:  Rec517Col

Categories: Risk Adjustment, RAPS, EDS
Tags: collaboration

Log on to Your Rise Account

Forgot your password?
Create an Account


Latest Posts

CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores. Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology. Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods. While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period. Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration. Also, we want to thank the health plans that actively participated in our study for making this work possible. ...
Read More

Take Aways from RISE Nashville Summit

The 11th Annual RISE Nashville Summit continued the event’s tradition of yearly growth. The return to downtown Nashville was widely applauded by attendees, who were glad to be back near Broadway’s nighttime funk and fun. While festive, this year's event occurred in the wake of the new administration in Washington, D.C., and the healthcare themes surrounding the "repeal and replace" of the Affordable Care Act (ACA) cast a long shadow. In contrast to the upbeat, confident notes struck by last year’s keynote speaker Senator Tom Daschle, this year’s sobering keynote address by Howard Fineman, NBC/MSNBC political analyst, The Huffington Post Media Group global editorial director, and bestselling author, was an assessment of the pluses and minuses of our new president. Mr. Fineman's remarks indicated that the political alliances in power will seek to undo what Senator Daschle viewed as "irreversible” a year ago....
Read More

Upcoming Conference


Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.


Upcoming Webinar

The Impact of Quality Incentive Models in Medicaid Markets


Thirty-one of our fifty states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Join this webinar to learn the typical quality payment approaches states use, issues often faced by health plans under each model and what states are expected to do with payment models tied to quality performance in light of near term Medicaid reform efforts.


Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.