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

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