MAP Medicaid
The primary purpose of risk adjustment in Medicaid is to provide adequate financing for the health plans/ACOs/MCOs that treat individuals with higher-than-average health needs. Risk adjustment models vary from state-to-state, which makes it hard for MCOs to maintain and run risk adjustment models.
Over 30 states use one of the six different Medicaid risk adjustment models for MCO reimbursement.
A few of the challenges which MCOs face with Medicaid risk adjustment programs are:
- Quality: Quality of data and timely reporting of encounter data required for risk adjustment purposes.
- No retrospective review: Unlike Medicare and ACA, most Medicaid programs do not allow retrospective chart review or supplemental submissions.
- Penalties: States are beginning to apply penalties on MCOs that do not submit complete data.
Manage Risk Adjustment for Medicaid Effectively
Invent Health’s MAP extends beyond claims data analytics: it also incorporates alternate data sources such as pharmacy and care management data to comprehensively identify all possible risk gaps. We use healthcare data to provide impact analysis and risk score gap closure by analyzing analytics through state-specific risk adjustment models like CDPS, ACG, and more.
With its rich experience, our risk adjustment team has significant encounter data submission knowledge and knows about its associated challenges across various states. This helps us create rich gap analysis, interpret risk score data flawlessly, and to find trending utilization and define workflows to close gaps.
The MAP’s Medicaid solution aims at engaging providers with timely, actionable data to improve outcomes. With the help of the MAP platform, health plans can perform utilization analysis to drive care management programs in Medicaid while supporting effective member engagement.
Key Features of MAP Medicaid
The keys features of the product are designed to assist across the Medicaid programs:
Unique, customizable client reports specific by issuer, plan, and provider levels.
ACG, CDPS, CDPS RX models are integrated in the platform to perform deep analysis.
MAP has APIs to integrate with the encounter submission process to prioritize high risk claims for submission.
Provide real-time or near-time access to the data to find ways to recommend behavior for submissions, provider coding errors, and supplemental data submissions.
Utilization analytical models help in care management and wellness program evaluation to drive health outcomes.
Data Ingestion and Risk Analytics
MAP-Medicaid supports various data inputs and helps in performing the analysis.
- Ability to intake 837, CSV, XML or a custom input of claims, pharmacy, and clinical data
- MAP can load and identify health condition gaps reported using our comorbid and historical models at the early state of data submissions.
