Health plans, IPAs, and provider groups
Comparison Options
The MAP performs risk adjustment reconciliation processes that allow health plans to compare the projected risk scores versus the actual ones, as well as provide concise data of members with risk score discrepancies. MAP also prioritizes data submissions, chart chase recommendations, and the effective closure of gaps.
The process of comparison includes intaking CMS reports, MAO004, and MOR data along with member preventive services such as annual wellness visits, quality metrics screenings, and provider chart review data for analysis. MAP then reports the discrepancies, prioritizes the data, and compares provider performance and risk score opportunities.
Maximum performance through our proprietary cyclical process enabled with actionable workflow:
All the reports and analytics are powered by Invent Health’s proprietary data science techniques which allow health plans to analyze and extract meaningful data insights.
Some of the key metrics that we compare and analyze across all lines of business are as follows:
- HCC/ CDPS recapture rates every single year
- Preventive services visit rates at PCP and provider group level
- Percentage of members with no encounters
- Percentage of members with PCP visits and HCC capture rates
As part of the user interface (UI), there are various enabled reports to manage the risk and quality opportunities effectively.
The following are some examples:
- HCC/care gap identification, gap closure recommendations (i.e. prospective, retrospective, or preventive services)
- Monthly provider performance report cards driving HCC recapture rates
- Monthly provider revenue opportunities to drive gap closure