RISE to Publish RAPS to EDPS Findings: Get the Scoop!

Those of us who participated in the call with CMS on Thursday morning heard that there are problems rolling out this transition from RAPS to EDPS and that CMS is closely focused on the issue.  However, the healthplans included in the RISE RAPS to EDPS transition data collaboration are already way ahead on this topic. I am very pleased to announce that RISE will be publishing the results of our study shortly, which will benefit all plans involved in the RISE community. 

Nearly a year ago, RISE initiated a collaboration with our technical partners at Inovalon.  Through the sponsorship from Jason Rose, Chief Strategic Development Officer at Inovalon, the support of their executive leadership and the hard work of the Inovalon team, data from a group of healthplans has been gathered and processed on their RAPS and EDPS data in a large scale benchmarking study. The pool of Medicare Advantage membership exceeds 1 ½ million lives, providing us with the range and scope to draw some important conclusions about how the transition will affect the RAF scores, and hence, the revenues of Medicare Advantage plans across the country as the program is phased-in this year and the years to follow. 

At this moment, preliminary findings are emerging that demonstrate a lot of variability and some concerning trends which are being further analyzed.  We will be publishing the final results next month for the RISE members to see.  In addition, we were recently informed that the major trade association for our industry requested a 75 minute panel discussion about the study at their conference in Las Vegas in mid-June, which coincides with our target date for publication of results.  Representatives of the RISE RAPS to EDPS steering committee will be involved in the panel, so if you are able to attend, you will hear first-hand about the findings.  Once we have the analysis prepared next month, we will be publishing it on the RISE website.  So stay tuned! 

Kevin Mowll, Executive Director


Categories: risk adjustment, CMS
Tags: RAPS, EDPS, CMS, study, data collaboration, RAF scores, Medicare Advantage payment

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.