Cotiviti, a leader in data-driven healthcare solutions, will be joined by Fallon Health, a nationally recognized not-for-profit healthcare services organization, at RISE National 2021 to present on optimizing in-home health risk assessments. Their virtual presentation, “In-Home Health Risk Assessment Programs (IHAs): Close Encounters of The Right Kind,” will focus on closing the gap between patient risk identification and risk mitigation to ensure members receive high-value care. Cotiviti will also be hosting a virtual showcase with advanced in-home primary care and risk adjustment services leader PopHealthCare (A Guidewell Company) on the intersection of risk and quality.
“As the Centers for Medicare & Medicaid Services (CMS) expresses concern that health plans are using In Home Assessments (IHAs) to elevate patient risk scores without delivering appropriate follow-up care, payers need strategies to improve their IHA and care management processes,” said David Costello, Ph.D., Cotiviti Senior Vice President of Risk Adjustment and Innovation. “Cotiviti looks forward to presenting solutions to this challenge at RISE with Fallon Health, offering health plans the opportunity to proactively improve their risk adjustment, quality, and payment outcomes.”
Dr. Costello will be joined by Fallon Health Vice President of Risk Adjustment Stacy Coggeshall for this presentation. The experts will draw from their successful work improving IHA implementation and operational processes to share how healthcare organizations can address the risk identification/risk mitigation conundrum. The duo will also share insights on the potential barriers to a subsequent provider encounter (e.g., facility, age, and disability) and compare the rate of hospitalizations and meaningful follow-ups in member cohorts that successfully completed or did not complete IHAs.
“Guided by our mission, making our communities healthy, Fallon Health is committed to looking at the whole clinical picture as we serve our diverse membership. By taking this approach, we are able to best ensure that appropriate resources can be directed,” said Todd Bailey, Chief Financial Officer for Fallon Health. “Fallon Health is pleased to have the opportunity to have Stacy Coggeshall present alongside Cotiviti as we share lessons learned and industry best practices in regards to in-home health risk assessment programs.”
Costello will also be joined by Cotiviti Senior Vice President of Performance Analytics and Quality Rachael Jones and PopHealthCare Chief Operations Officer for Risk Adjustment Arturo Diaz for a virtual discussion focused on how strategic payer initiatives, such as value-based care, intersect risk adjustment and quality improvement programs. In the session, the panelists will discuss how telehealth utilization, in-home assessments, and Star Ratings trends can influence risk and quality programs, as well as how this impacts health plans’ future strategies.
Cotiviti’s session with Fallon Health will take place on Monday, March 29 at 3:00 p.m. ET. The virtual showcase will take place Tuesday, March 30 at 9:15 a.m. ET. Learn more about Cotiviti’s presence at RISE National 2021 at this link.
Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. Cotiviti’s healthcare solutions are powered by Caspian Clarity, a proprietary data and analytics platform spanning thousands of unique member and provider data types across financial and clinical domains, representing the most comprehensive longitudinal data set in healthcare. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit www.cotiviti.com.
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.