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The Medicare Advantage (MA) program has experienced tremendous growth. This trend is expected to continue in the coming years, as evidenced by the vast scope of options available during the Medicare Advantage 2022 open enrollment period. On the other side, Medicare Advantage Plans may face service constraints. It's not an effective way, and there are several causes for such discrepancies, but the good news is that they may be addressed with the correct methods and tactics.   Gaps can occur when Medicare Advantage Plans do not have strong relationships with provider organizations and medical institutions. It can lead to missed opportunities to work with the care coordination team to prevent gaps from forming in the first place.   It is Critical To Keep An Eye on HCC Close Gaps   CMS's risk-adjusted value-based payment scheme for Medicare Advantage plans employs the Hierarchical Condition Category HCC Codes , a compilation of diagnoses. The HCC Codes are the most

Population Health Management (PHM) is a specific form of care that includes prevention, vigilant access to health services, and community involvement in the healthcare setting. The Population Health Management Platform converts healthcare delivery from reactive to proactive monitoring for a specific population group at the lowest possible cost. Due to the drastic revolution in the healthcare system's service delivery and financing procedures, the Population Health Management Platform is becoming increasingly relevant. It works alongside a value-based care system, a reimbursement model used by public and commercial health insurance companies, Accountable Care Organizations (ACOs), and healthcare professionals. The value-based care model and Population Health Management emphasize delivering top-quality treatments while lowering the financial burden by directing resources toward outpatient services to reduce re-hospitalizations. Likewise, the payments have now become primarily p

Adopting value-based care programs and incorporating technology for high clarity is propelling the healthcare industry to acknowledge the increasing relevance of the Risk Adjustment Solution in various health insurance programs. Furthermore, the innovative government interpretations of legal responsibility connected to Risk Adjustment (RA) and precise reporting are fueling the momentum for modern tools that allow the analysis of health data variables to level-set assessments of member wellbeing. The Process of Risk Adjustment Solution at Its Most Basic Level The Centers for Medicare & Medicaid Services (CMS) employs Risk Adjustment to modify capitated disbursements (the payment is calculated per member per month). It is due to Medicare Advantage Organizations and other risk-bearing insurance organizations to reflect changes in predicted recipient health expenditures. CMS estimates Risk Adjustment payments based on the demographics of recipients and the diagnosis codes provide

A Population Health Management (PHM) company that strives to link patients to their whole care continuum seeks to get the best outcomes with Artificial Intelligence, Machine Learning driven, cloud-based, automated, and patient-centric Population Health Management Platform to tackle difficulties connected to patient-centered coordinated care. An effective Population Health Management Platform includes solutions for care management, utilization management, comprehensive pharmacy including the community and specialty pharmacies. It also incorporates Provider Services to meet the needs of payors, providers, and pharmacies such as electronic health record, revenue cycle management, and practice management system. Such fully automated systems are already in use by many of today's largest and most prominent healthcare institutions. PHM software providers have dedicated themselves to developing Pop Health solutions to address the issues of the fragmented healthcare market. The developme