Member engagement: Knock down barriers and learn to delight plan members
Address challenges head on: Don’t wait until the fourth quarter to ask members about their challenges, suggested Gerri Cash, vice president, Medicare & FEP quality improve performance, Blue Cross Blue Shield of Arizona, during a case study presentation on getting members to needed care and delighting them in the process. Ask them throughout their journey. The process must be dynamic.
Get them the care they need: Don’t just tell members how, do it for them, Cash said. Don’t keep them on the phone for 45 minutes, when it can be done in five minutes. And remember to follow-up with them, remind them of appointments, and reschedule if necessary.
Delight them with the member experience: Express empathy even when they vent. Provide them with a dedicated care concierge team and remove burdens. Don’t just schedule the appointment, ask about transportation issues and their other needs.
Payer and provider preparation tips for RADV audits
Deb Curry, director, risk adjustment & recoveries, Paramount Health Plan, and Jenni Monfils, AVP risk adjustment coding and compliance, Bright Healthcare, offered the following advice during the panel discussion on how to prepare for RADV audits.
Follow best practices: Conduct retrospective audits (back to PY 2018), establish internal coding ethics, and create a RADV “playbook,” that includes who is on the audit team, roles and responsibilities, timelines, and the communication plan.
Help payers mitigate risk by:
Ensuring accurate coding: Conduct quarterly internal audits, get new coding books every year, provide access to AHA Coding Clinics, review Official Coding Guidelines annually, know the Centers for Medicare & Medicaid Services’ (CMS) HCC model, use CMS resources.
Being mindful of the in-homes: Know the difference between in-home care versus in-home assessments, and review Senate Bill 1002: “No Up Coding Act.”
Budget accordingly: Build in costs for future audits and potential findings, save records requested for retrospective reviews (reduces duplication & costs).
Build a peer network: Connect with peers to share insights, frustrations, battle scars, and wins.
Engage with providers: Collaborate closely with providers.
Providers can mitigate risk by:
Seeing chronically ill patients at least once a calendar year.
Document the diagnosis, status, plan, and sign the chart.
Code to the highest specificity: Be code focused, not HCC focused. If the code is accurate, it will fall into the accurate CMS model.
Make health equity initiatives more successful
Rick Whitted, CEO, U.S. Hunger, and Ana Handshuh, principal, CAT5 Strategies, offered the following tips during a session on how to incorporate health equity into your plan’s quality measures performance:
Acknowledge racial disparities that are prevalent in health care.
Trust building strategies that combat shame and worry that are associated with asking for support.
Ensure inclusivity, accessibility, linguistic, cultural responsiveness, and cultural humility to help best understand what comes along with the populations you serve.
Understand systemic barriers that impact people and have resulted historically in fear and mistrust.
Respect peoples’ self-determination. Make sure you authentically incorporate their perspective into their care.
Bring together local and community-based resources to enhance accessibility to what they need.