Milliman MedInsight has introduced a new risk adjustment platform designed to enhance healthcare organisations’ risk management and clinical documentation.
The Milliman MedInsight Risk Adjustment Platform uses AI-driven technology and industry expertise to optimise risk workflows, allowing healthcare providers to track performance and manage financial risks.
The platform offers several key advantages, including unified health records from all major national networks and direct APIs, and bridging the gap between claims and medical records.
The integration of claims and medical records simplifies workflows, enhances documentation accuracy, and improves response tracking.
It allows for easy storage, retrieval, and future access to queries and reports.
Milliman principal and consulting actuary Noah Champagne said: “Risk adjustment accuracy is becoming increasingly important as Medicare ACOs (including those participating in Medicare Shared Savings Program (MSSP) and ACO REACH) and Medicare Advantage (MA) plans continue to grow.
“These programs rely on accurate risk assessment to ensure that health plans and providers are fairly compensated for the care they deliver.”
The platform enhances coding compliance by identifying isolated errors versus systemic provider issues, ensuring accurate coding and targeted training.
Its proactive care identification feature quickly pinpoints beneficiaries who may benefit from additional care, such as in-home visits.
Also, the risk adjustment platform provides detailed insights into provider quality, financial performance, and risk levels are provided down to the individual NPI.
It is powered by the Milliman ACO Builder and Milliman Medicare Advantage Network Intelligence, along with quarterly lagged Medicare national data.
In addition, the platform’s peer comparison tools leverage comprehensive Centers for Medicare and Medicaid Services (CMS) data to offer a competitive advantage.
Milliman MedInsight said that its Risk Adjustment Platform promises easy implementation and integration with current workflows and is supported by clinical coders and clinicians.
Milliman MedInsight payer solutions chief market strategist Marcos Dachary said: “The Risk Adjustment Platform enables us to fully achieve our vision of tackling the complexities and coordination challenges between providers and patients.
“The combination of MedInsight’s actionable intelligence and data enrichment platform with clinical and documentation workflows will create a comprehensive solution that is truly unique and unmatched in the market.
“This marks a significant step forward in helping customers meet regulatory requirements and enhancing the quality of care they provide to their patients.”
