Risk Management
RISK MANAGEMENT
When doctors, hospitals, and other healthcare providers are being negatively compared to other providers by cost, the most common reaction is, "That is not fair. My patients are sicker." Fee-For-Value now considers that.
Providers need help to support their belief that their patients are sicker. Risk assessment relies on the skill set of the doctor evaluating and treating the patient. It predicts a person's likelihood of having a poor health outcome. Medicare uses this to predict illness-related costs. Most of us know that Fee-For-Value programs adjust your compensation based on your ability to impact this cost.
Risk assessment is the most technically challenging but financially rewarding part of Fee-For-Value. Most importantly, it also turns out to be the most rewarding for patient outcomes. Since lifestyle is the most critical determinant of patient health, understanding their health risk is crucial.
Risk assessment is something only doctors can do; it's based on understanding medicine. However, being a great doctor is not enough. You have to learn and understand risk scores as well. Medicare has been watching the clinical risk indicators in their specific population and payment programs. They assign risk values based on their costs.
Working with our doctors-hyperlink to service- that know both medicine and Medicare Risk Assessment, you can learn this, too. It makes such a difference for you and your patients. It even impacts your family because of your ability to spend more time at home.
We have state-of-the-art resources to help you understand Risk Assessment:
1.Timbie JW, Bogart A, Damberg CL, Elliott MN, Haas A, Gaillot SJ, Goldstein EH, Paddock SM. Medicare Advantage and Fee-for-Service Performance on Clinical Quality and Patient Experience Measures: Comparisons from Three Large States. Health Serv Res. 2017 Dec;52(6):2038-2060. doi: 10.1111/1475-6773.12787. PMID: 29130269; PMCID: PMC5682140https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682140/
2. King, R. Medicare Advantage plans achieve better outcomes than traditional Medicare, BMA analysis finds. Fierce Healthcare Dec, 2020.
3. Ayanian, J. Z. , Landon B. E., Zaslavsky A. M., Saunders R. C., Pawlson L. G., and Newhouse J. P.. 2013. "Medicare Beneficiaries More Likely to Receive Appropriate Ambulatory Services in HMOs Than in Traditional Medicare." Health Affairs (Millwood) 32 (7): 1228–35.
4. Elliott, M. N. , Landon B. E., Zaslavsky A. M., Edwards C., Orr N., Beckett M. K., Mallett J., and Cleary P. D.. 2016. "Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts." Health Affairs (Millwood) 35 (3): 456–63.
5. Gold, M. , and Casillas G.. 2014. "What Do We Know about Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?" https://www.kff.org/medicare/report/what-do-we-know-about-health-care-access-and-quality-in-medicare-advantage-versus-the-traditional-medicare-program/
6. Keenan, P. S. , Elliott M. N., Cleary P. D., Zaslavsky A. M., and Landon B. E.. 2009. "Quality Assessments by Sick and Healthy Beneficiaries in Traditional Medicare and Medicare Managed Care."
7. Landon, B. E. , Zaslavsky A. M., Bernard S. L., Cioffi M. J., and Cleary P. D.. 2004. "Comparison of Performance of Traditional Medicare vs Medicare Managed Care." Journal of the American Medical Association 291 (14): 1744–52.
Ready to find out more?
Call us at 859-721-1414 or email us. Your patients deserve it. Your family deserves it. You deserve it!