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Risk Adjustment Roundtable: Key Performance Metrics

Event Date: 5/6/2021

Event Overview

Thursday, 5/6/2021
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: Sentara Health Plans

Curious what risk adjustment key performance indicators other health plans are using? Alliance members recently shared a number of ideas on the discussion forum. During this call, we’ll go deeper. Dean Ratzlaff, actuary at Sentara Health Plans (Optima), will elaborate on their approach. Then we’ll open up the line and the chat for everyone to weigh in and share.

Key performance indicators we will discuss include:

  • Within the department: Chart review and IHA intervention KPI’s used by Risk Adj managers to assess an intervention while it is being conducted.
  • Outside the department: KPI’s given to executives for three interventions: 1) Data integrity 2) Chart Review 3) IHA – as well as non-intervention KPI reporting. Emphasis will be on the art of messaging to stakeholders.
  • Risk scores and dollars: What Sentara Health Plans keeps for its ACA, MA, McD lines, and what it reports to others in the company for pricing and financial accruals.
  • Provider Engagement: Discussion regarding challenges and successes in measuring provider engagement efforts.

 

 Are there other KPI topics you would like to discuss? Post your ideas to this discussion forum thread.


Audience

Risk adjustment and quality leaders and those with responsibility for risk adjustment and quality reporting or dashboards.


 

Ask your peers a question or share a resource anytime through the Alliance discussion forum

You can visit the discussion forum and post a question anytime. It's only available to Alliance members, so your question is private and secure. When submitting a question, you can select which topics your question is related to. Individuals who have indicated in their Alliance profile they are interested in those topics and are opted in to discussion forum emails will receive your question. You can also add an attachment to your question or reply, making this tool another great resource for sharing best practices with your peers.

Start a discussion

 



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Documents
5/10/2021

Recording: Risk Adjustment Roundtable: Key Performance Metrics
Curious what risk adjustment key performance indicators other health plans are using? Alliance members recently shared a number of ideas on the discussion forum. During this call, we’ll go deeper. Dean Ratzlaff, actuary at Sentara Health Plans (Optima), will elaborate on their approach, then we’ll open up the line and the chat for open discussion.

5/10/2021

Presentation: Risk Adjustment Roundtable: Key Performance Metrics
Curious what risk adjustment key performance indicators other health plans are using? Dean Ratzlaff, actuary at Sentara Health Plans (Optima), elaborates on their approach.

5/10/2021

Intervention Tracker
Spreadsheet for risk adjustment intervention tracking. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/10/2021

Intervention KPIs
Spreadsheet for risk adjustment intervention KPIs. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/10/2021

Intervention Return
Spreadsheet for risk adjustment intervention ROI. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/6/2021

Nested Egg Model of Risk Score Accuracy
Provides a visual aid for explaining that there are several layers to a member's risk score. There is the member's actual medical complexity, what's documented, what's coded and then what's accepted by CMS for aged and disabled, dual eligibles and members with End Stage Renal Disease (ESRD). Drawing by Dean Ratzlaff, Actuary, Sentara Health Plans (Optima) at an Alliance Risk Adjustment at an in-person meeting converted into a PowerPoint slide by the IU Health team.

Attendees

Below is a list of all delegates registered to date for this event

  • Samantha Aaron
  • ALLIANCE MEMBER
  • Pharmacy Process Audit Technician II at Sharp Health Plan
  • Rick Alexsonshk
  • ALLIANCE MEMBER
  • Director ACA Risk Adjustment at SummaCare
  • Katie Anderson
  • ALLIANCE MEMBER
  • MGR, Risk Adjustment Analytics at Sentara Health Plans (Optima)
  • Sarah Anzick
  • ALLIANCE MEMBER
  • Manager, Quality Improvement at Sentara Health Plans (Optima)
  • Lori Asmus
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Network Health
  • Steve Ayotte
  • ALLIANCE MEMBER
  • Manager of Risk Adjustment Analysis at Neighborhood Health Plan of Rhode Island
  • Julie Bartels
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Quartz Health Solutions
  • Terri Bowers
  • ALLIANCE MEMBER
  • HCC Risk Adjustment Analyst at Providence Health Plan
  • Sibyl Boyd
  • ALLIANCE MEMBER
  • Medical Department Coordinator/Certified Risk Adjustment Coder at Cox HealthPlans
  • Misty Boyd
  • ALLIANCE MEMBER
  • Consultant - Compliance at IU Health Plans
  • Gerald Bradford
  • ALLIANCE MEMBER
  • Chief Financial Officer at Health Alliance Medical Plans
  • Danielle Brinkley
  • ALLIANCE MEMBER
  • Director, Population Analytics at Community Health Plan of Washington
  • Kristin Calkins
  • ALLIANCE MEMBER
  • SIU Investigator at Quartz Health Solutions
  • Wynda Clayton
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Providence Health Plan
  • Deb Curry
  • ALLIANCE MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • D De Roche
  • ALLIANCE MEMBER
  • Manager, Goverment Programs at Community Health Options
  • Crystal Djordjevic
  • ALLIANCE MEMBER
  • Risk Adjustment Education Specialist at Health Alliance Medical Plans
  • Alison Dunton
  • ALLIANCE MEMBER
  • Director of Practice Enhancement & Analytics at Aspire Health Plan
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Art Edgerton
  • ALLIANCE MEMBER
  • Medical Director at FirstCarolinaCare Insurance Company
  • Lindsay Erickson
  • ALLIANCE MEMBER
  • Director, Quality Analysis & Risk Adjustment at Community Health Plan of Washington
  • Lisa Garrett
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Sentara Health Plans (Optima)
  • Kaitlyn Hammond
  • ALLIANCE MEMBER
  • Director of Government Programs at Cox HealthPlans
  • Sara Hansen
  • ALLIANCE MEMBER
  • Senior Director, Population Health & Clinical Operations at Avera Health Plans
  • Jean Harantha
  • ALLIANCE MEMBER
  • Senior Analyst at Paramount Health Care
  • Amber Harris
  • ALLIANCE MEMBER
  • Director Risk Adjustment at MediGold
  • Jenny Hudson
  • ALLIANCE MEMBER
  • OP CDI SPECIALIST at Henry Ford Health System
  • Donna Ives
  • ALLIANCE MEMBER
  • EDI&Encounter Data Specialist at Health Alliance Medical Plans
  • Frank Izquierdo
  • ALLIANCE MEMBER
  • SVP, Provider Solutions & Strategic Alliances at AvMed
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Erin Kalagher
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Specialist at Health New England
  • Patricia Karam
  • ALLIANCE MEMBER
  • Risk Adjustment Specialist at Community Health Plan of Washington
  • Erin Kavanagh
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Samaritan Health Plans
  • Kaesie Kettinger
  • ALLIANCE MEMBER
  • Senior Risk Adjustment Auditor at Paramount Health Care
  • Christopher Kirk
  • ALLIANCE MEMBER
  • Vice President, Health Care Economics at Jefferson Health Plans
  • Tina Korty
  • ALLIANCE MEMBER
  • Vice President, Health Plans Legal, Compliance & Regulatory at IU Health Plans
  • Ed Lee
  • ALLIANCE MEMBER
  • Product Leader, Health Plans Medicare Advantage at IU Health Plans
  • Michele Lerch
  • ALLIANCE MEMBER
  • Manager - Risk Adjustment at Geisinger Health Plan
  • Tammy Little
  • ALLIANCE MEMBER
  • Risk Adjustment Team Coordinator at Sentara Health Plans (Optima)
  • Luce Lohier
  • ALLIANCE MEMBER
  • Director, Government Programs Reimbursement at AvMed
  • Jeanne Lui
  • ALLIANCE MEMBER
  • Risk Adjustment Coordinator at CCHP
  • Stephne Morgan
  • ALLIANCE MEMBER
  • Risk Adjustment Program Manager at Health New England
  • Stephen Muldoon
  • ALLIANCE MEMBER
  • Manager, Actuary at Sentara Health Plans (Optima)
  • Cathy Nagy
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment Coding and Education at Health Alliance Plan (HAP)
  • Dennis Ortiz
  • ALLIANCE MEMBER
  • Risk Adjustment Business Analyst at Sentara Health Plans (Optima)
  • Kari Pace
  • ALLIANCE MEMBER
  • Clinical Documentation Improvement Nurse-Risk Adjustment/Quality Management at Medical Associates Health Plans
  • Wade Penner
  • ALLIANCE MEMBER
  • Manager Revenue-Risk at Samaritan Health Plans
  • Ariana Ricci
  • ALLIANCE MEMBER
  • Risk Adjustment Analytics Lead at Neighborhood Health Plan of Rhode Island
  • Lawrence Roberts
  • ALLIANCE MEMBER
  • Business Analyst at Sentara Health Plans (Optima)
  • Robynn Roy
  • ALLIANCE MEMBER
  • Quality and Risk Adjustment Specialist at Avera Health Plans
  • Kathleen Schofield
  • ALLIANCE MEMBER
  • Manager, Strategy at Community Health Plan of Washington
  • Susan Sirek
  • ALLIANCE MEMBER
  • Sr. Business Data Analyst at Sharp Health Plan
  • Barb Smith
  • ALLIANCE MEMBER
  • Clinical Review Coder - Avera Health at Avera Health Plans
  • Caryn Smith
  • ALLIANCE MEMBER
  • Director of Risk Adjustment at HealthTeam Advantage
  • Krystal Stevenson
  • ALLIANCE MEMBER
  • Manager- Risk Adjustment Programs & Operations at Health Alliance Plan (HAP)
  • Laurie Tucker
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Specialist at Mount Carmel Health System
  • Diana Vasquez
  • ALLIANCE MEMBER
  • Senior Risk Adjustment Coding Specialist at Neighborhood Health Plan of Rhode Island
  • Benjamin Vereecke
  • ALLIANCE MEMBER
  • Director - Risk Adjustment & Encounter Data Submissions at Health Alliance Plan (HAP)
  • Erika Vilchez
  • ALLIANCE MEMBER
  • Medicare Operations Analyst at MetroPlusHealth
  • Jeremy Wade
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Community Health Plan of Washington
  • Desiree Walke
  • ALLIANCE MEMBER
  • Risk Adjustment Compliance Analyst at Quartz Health Solutions
  • Nancy Weber
  • ALLIANCE MEMBER
  • Clinical Integration Program Manager at Network Health
Speakers