Affordable Care Act (ACA)
About
Affordable Care Act (ACA) implemented risk adjustment and reinsurance programs, providing financial support to health plans that enroll higher-risk individuals, thereby mitigating potential financial losses and enhancing revenue stability.
Advantages
Improve Financial Performance
Through comprehensive financial assessments and analyses, identify areas of potential improvement and develop strategies to enhance revenue streams and cost management.
Optimize Risk Scores
Assess IVA RADV Processes and Performance
Solutions
Predictive Models
RaLytics has developed predictive models to determine the risk of specific disease conditions. The models are based on care patterns indicated in the utilization data associated with specific conditions.
RaLytics models give issuers the opportunity with their own utilization data to do the following:
- Use RaLytics models to predict HCCs reported in EDGE but unlikely to be supported in the IVA RADV audit. Identifying areas of IVA vulnerability allows the plan to prioritize medical record acquisition efforts
- Use RaLytics models to predict HCCs likely to be currently under treatment to secure complete EDGE and supplemental file submissions.
- Prioritize provider feedback and CDI efforts.
- Use RaLytics models to assist plans in estimating their risk relative to the risk in the market as part of their analyses for estimating their transfer payment.
- Models combining Edge and client data can help plans estimate overall risk in the market.
- Leverage client data to estimate individual plan risk.
Let's Connect
Revolutionize your healthcare organization with RaLytics™! Our tailored solutions drive excellence for health plans, providers, and government agencies. Contact us today to discover how our expertise can drive success for your organization.