Empirical Risk Management
Kameron Gifford, CPC
Todd Gifford, MBA
Visit Global Health Care Management Systems for on-demand courses in Medicare Risk Adjustment, ICD-10 and Rapid Practice Innovation.
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*Coding and Compliance
*Mangaged Care and Medicare
*Patient Centered Medical Homes
HOW WE CAN HELP
- Identify gaps in coding and documentation that lead to inaccurate risk profiles
- Utilize multiple sources of information to transition providers into a prospective system
- Provide education and training specific to the needs of each individual practice
- Implement and monitor improvement plans to ensure 95% accuracy of claims
- Design and initiate compliance plans to ensure protection against state and federal penalties
- Analyze, collect and improve HEDIS measurements across every practice
- Increase member awareness and understanding of chronic diseases through outreach programs
- Documentation and revenue risk assessments proceeding transition into ICD-10
- Provide comprehensive ICD-10 transition services that include planning, education, implementation and monitoring
The Next Wave of Disruptive Innovation
Medicine is destined to be the most regulated industry
in the world. The current culture of healthcare in America challenges
traditional business models on everything from cost to implementation to how we
gather feedback about the patient experience. This paramount shift in the way
we evaluate our physicians and choose our health plans further supports the
need for continual innovation. In this new generation of due diligence, the
entire healthcare community has become accountable not only in the state and
federal courts but in the court of public opinion as well. This new arena
demands strong fiscal oversight, tangible transparency and outcomes that are
determined by the level of patient engagement. The old boardroom dialogue,
centered around the acquisition and internal uses of big data, have given way
to new questions. Senior executives and are now asking, “How do we get our
members excited about using all of this data?”
The fact that this question is now being asked by the most influential decision
makers in healthcare signals the beginning of a new kind of disruption, a
This digital disruption will be pioneered by leaders using technology to create
innovative platforms to engage patients and change behavior. The champions of
the future will be determined by the individual capacity of a corporation to
modify and adapt. Inventions will no longer depend on handcrafted products but
instead be shaped from ideas, concepts and processes presented across multiple
platforms that can be accessed from anywhere any time any place.
The health plan of the future will engage patients through digital apps that
can monitor compliance, Create custom QR Codes for HEDIS Measures to allow for
real time tracking, all while assessing member satisfaction with the plan,
pharmacy benefits and primary care providers.
In fact, the tools themselves will have nothing to do with the digital
disruption, it will be the meaningful ways in which we use these tools to meet
the needs of patients. Success or failure will be contingent not on what you
create but what you do with it next.
The cost of healthcare is unsustainable. First premiums were raised to try and
get consumer involvement. That was followed by employing variable cost shares
and quality incentives. None of which have influenced behaviors. Perhaps
because all of those affect us indirectly. Innovative platforms such as Apps
have been able to reach their audience in the most intimate of places.
Are you prepared for the digital disruption?
Kameron Gifford, CPC