Software provides Medicare risk adjustment.March 4, 2009 -
Incorporating Johns Hopkins ACG System for provider profiling, predictive modeling, resource management, and rate adjustment, DSTHS RiskAnalyzer(TM) determines where provider coding is not capturing disease conditions under CMS-HCC model. Program provides objective set of rules to prioritize provider and member records for chart audit through identification of potentially incomplete or inaccurate patterns of coding, either retrospectively or prospectively.
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Original Press release
DST Health Solutions, Inc.
2500 Corporate Dr.
Birmingham, AL, 35242
USA
DST Health Solutions Launches New RiskAnalyzer Software to Help Medicare Advantage Plans Manage Risk Adjustment
RiskAnalyzer Incorporates Johns Hopkins ACG System for Provider Profiling, Predictive Modeling, Resource Management and Rate Adjustment
BIRMINGHAM, Ala., Feb. 19 /-- DST Health Solutions today announced the launch of its new Medicare risk adjustment software, DSTHS RiskAnalyzer(TM). RiskAnalyzer uses claims experience to determine where provider coding is not capturing disease conditions under the Centers for Medicare and Medicaid Services Hierarchical Conditions Category (CMS-HCC) model. It provides an objective set of rules to prioritize provider and member records for chart audit through identification of potentially incomplete or inaccurate patterns of coding -- either retrospectively or prospectively.
RiskAnalyzer is part of DST Health Solutions' CareAnalyzer(TM) analytics solution, which helps health plans identify high-risk members for care management. RiskAnalyzer and CareAnalyzer support appropriate member management with integrated report views of cost, quality and risk.
"In 2007, CMS completed the phase-in of risk-adjusted payments for Medicare Advantage plans based on the CMS-HCC model," said Amy Salls, Business Solutions Director for Decision Support, DST Health Solutions. "The goal of risk adjustment was to pay Medicare Advantage plans based not only on member demographics, but also on health status. This means that plans with the most effective risk adjustment optimization programs will have revenue that more accurately reflects their true risk."
RiskAnalyzer is designed to help health plans evaluate claims based on the likelihood of missed diagnosis codes. The software can also help plans identify mid-year variances while there is still an opportunity to appropriately document member risk factors.
RiskAnalyzer incorporates the ACG System, a peer reviewed methodology for provider profiling, predictive modeling, resource management, and reimbursement rate adjustment. The ACG System provides a robust application for capturing disease burden and risk from medical claims. It also incorporates a unique pharmacy model that relates prescribing practices to patient morbidity, providing another route to pick up diagnoses that may have been missed by medical claims. The ACG System was developed by The Johns Hopkins University Bloomberg School of Public Health, and is distributed exclusively by DST Health Solutions.
About DST Health Solutions
DST Health Solutions, LLC delivers systems and services that help improve efficiency, reduce operational costs, increase speed to market, facilitate medical cost management and price containment -- improving both member experience and service for commercial health plans, consumer-directed plans, government plans (Medicare Advantage, Medicare Part D and Medicaid) and physician practices. DST Health Solutions' enterprise applications and ASP and BPO services include claims processing, member and provider management, benefit plan management, new product development, care management and medical management, and decision support/analytics supporting nearly 400 clients representing 40 million lives. For more information about DST Health Solutions, contact 800.272.4799, e-mail inforequests@dsthealthsolutions.com or visit www.dsthealthsolutions.com.
Web Site: http://www.dsthealthsolutions.com/
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