Risk Optimization
We understand the strategies necessary to optimize risk adjustment, while simultaneously delivering additional value and better performance across your value based care, care management and quality programs.
Risk optimization is all about accuracy, quality and a prospective view of risk and opportunity – rather than a retrospective one.
Our approach enables you to build high value data assets, insights that are tuned to your unique needs, and advanced algorithms you own and can use to dramatically improve your risk adjustment performance.
Our Risk Optimization Solution Framework can be used to support improvement in a wide variety of related business and member strategies, including value based care, care management and quality programs. Any technology platform, any set of vendor relationships, any proprietary insights... our framework brings the pieces together to help you accelerate your path to better performance.
Risk Optimization Solution Framework
Organize & Integrate Member Data
Successful member level data quality and integration capabilities are foundational to the business and clinical processes of today’s health plan
Risk optimization strategy development and implementation support
As risk programs evolve towards deeper integration with care quality and population health platforms – and as increased automation and integration with internal and vendor systems causes additional complexity – a well- defined and tightly managed strategy becomes even more imperative to success.
In addition to supporting our clients in mission-critical risk adjustment capability development, our practice can also support your organization in establishing and nurturing a comprehensive risk adjustment program, across a wide variety of strategic and technical needs. Our seasoned healthcare and technical practitioners can work with you to deliver successful:
- Strategy Alignment – validate and refine current strategy and capabilities to ensure optimized efficiency, automation and accurate risk adjustment processes – as well as alignment with emerging value based care, population health and care / quality management programs.
- Solution Architecture Design – build and refine a digestible and usable business solution architecture that can evolve as the breadth and complexity of your risk adjustment program becomes more integrated with other business units and objectives.
- Change Management – evaluate organizational readiness to support new processes and organizational needs associated with enhanced, new vendor / internal data assets and new points of integration across the organization (e.g. population health platforms, clinical data, VBC contractual arrangements). Deliberate focus on organizational change activities to ensure change is realized in impacted areas of the organization.
- Custom Solution Delivery and Vendor Implementation – evaluate investment decisions on critical solution components (e.g. engagement technology, data and analytics solutions, etc.) and drive end-to-end technology delivery whether vended or custom, spanning requirement definition through deployment.
- Program and Project Management – manage overall program and individual projects to measurable progress and outcomes and with consistent and rigorous methodologies that can be applied to all initiatives; including program approach definitions, custom and vended technology solution deployments, and organizational and process design work.