Building Effective Health Assessments by Improving Member Targeting

Identifying and prioritizing the member population that can benefit the most from health assessments is essential for health plans to obtain the best results.
 
This session takes a deep dive into how to build a list of beneficiary prospective gaps in care for HEDIS and RA that results in the best outcomes. Attendees will also learn about how to execute on an HRA program and measure ROI.

Top 5 Takeaways

  • How to create a list of high priority members 
  • How to prioritize that list for outreach
  • How to maximize the use of data analytics (PQR, pharmacy and diagnostic claims data) in order to identify members with open gaps
  • How to leverage an in-home health assessment program
  • How to increase the HCC Recapture Rate in the home setting by performing a pre-HRA Medical Record Review

 

Presenters

Sujata Bajaj, Vice President of Product Development
 
Vice President of Product Development has over 10 years of experience leading the development and delivery of healthcare technology solutions. Her prior experiences have included developing MA, MSSP/ACO, Medicaid and exchange ACA related applications. She has deep experience in building risk adjustment analytics, CMS EDS submissions, gain/risk share reporting, HEDIS reporting and taking health plans to the coveted 4 plus STAR rating.

Episource © 2018
FAHP Summer Webcast Series  |  September 27, 2018 at 2:00pm EST

Rulph Lamour, Medical Director and V.P. of Clinical Services
 
Dr. Rulph Lamour is Episource’s Medical Director and V.P. of Clinical Services. He is a physician with a combined 17 years of experience in patient care, risk adjustment, HEDIS/STAR Rating programs, medical record review and coding, HCC/RAF education and clinical research. He graduated from the School of Medicine of Pontificia Universidad Catolica Madre y Maestra in Santiago, Dominican Republic.
 
From 2013 to current date, Dr. Lamour has been involved in the Risk Adjustment and Quality Improvement Industry where he has held several leadership positions and acquired a Coding Risk Adjustment Certificate (CRC). During these past years, he has improved his skills as a Risk Adjustment/HCC subject matter expert and Analyst and educated numerous first and second level providers on risk adjustment, the proper use of HCC codes and the appropriate corresponding clinical documentation to support these codes. He is also a frequent speaker at different healthcare conferences such as RISE and Healthcare Education Associates events.

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