Persivia

Version 24 to Version 28 represents the most recent and substantial change in the Medicare Advantage HCC Coding . Medical Advantage Organizations (MAOs) and healthcare organizations must consider the broad effects of this change.  We must first realize the relevance of HCCs in Medicare Advantage to fully understand the change from V24 to V28. To forecast future costs and payments for patients in Medicare Advantage plans, HCCs were created by Medicare. Concerns have been raised about upcoding in these programs, which could result in excessive payments. The Centers for Medicare & Medicaid Services (CMS) intends to solve these issues by enhancing the HCC Coding methodology. The Medicare Advantage Reimbursement Model Shared risk between providers and payers underpins the Medicare Advantage (MA) reimbursement paradigm. It is based on a risk adjustment model that forecasts future expenses using historical claims data, resulting in provider payments. After the industry adopted ICD

In the prompt-paced domain of healthcare technology, one name shines as a symbol of innovation and excellence - Persivia. This dynamic company has carved a niche for itself with its end-to-end population health management (PHM) solution, driven by artificial intelligence. What makes Persivia truly stand out is its recognition of the highly respected Gartner Hype Cycle reports for 2023.  Embracing Excellence: Persivia's Gartner Recognition Persivia's achievements have not gone unnoticed. Its inclusion as a notable player in three crucial Gartner reports for 2023 is a testament to its expertise and impact in the field. These reports are: Gartner® Hype Cycle™ for Healthcare Data Analytics and AI Gartner® Hype Cycle™ for U.S. Healthcare Payers Gartner® Hype Cycle™ for Healthcare Providers 2023   Securing a spot in these influential reports underscores the organization’s dedication to pioneering innovation. Decoding the Gartner Hype Cycle for Populati

The Accountable Care Organizations (ACO) Realizing Equity, Access, and Community Health (REACH) initiative, launched by CMS, is a ground-breaking program. This initiative is poised to revolutionize the healthcare industry by extending its reach to a broader spectrum of beneficiaries. While the core objectives remain similar to its predecessor, the focus of ACO Reach is now firmly on addressing disparities and promoting inclusivity within the system. As the expected implementation date draws near, there is growing curiosity about whether the existing infrastructure can effectively accommodate the demands of this expanded approach. Let’s shed light on the elements that make it successful. Recapping ACO Reach Solution  The Redesigned Perspective New focus areas are introduced by the ACO Reach Solution to reach a larger audience. To achieve this, participants are tasked with reforming administrative policies, addressing disparities in underserved communities, and enhancing data tr

When speaking of value-based care, effective care management plays a pivotal role. This approach centers on patient-focused, collaborative strategies aimed at helping individuals manage their medical conditions efficiently and affordably. A Care Management Platform encompasses various essential components, including care coordination, medication management, patient education, and personalized care plans. The ultimate goal is to reduce healthcare costs, minimize hospitalizations, and stimulate optimal patient care. Further, while care delivery is primarily associated with healthcare providers, payers also have a significant role to play in this essential process. Care Management For Payers | The Role To Play  As administrators of health plans, payers hold a unique position that allows them to facilitate member access to an effective Care Management Solution . Here are some ways in which payers can contribute: Financial Incentives Payers can encourage their members to pa

Care managers play a vital role in ensuring that patients receive the best possible care tailored to their unique needs. These healthcare professionals wear multiple hats, from being patient advocates to care-team collaborators, care-plan creators, and patient and family educators. They navigate the complexities of a constantly changing healthcare system, where patients receive care from various providers, each specializing in a specific area of treatment. Let’s find out what is care management and what the top six guidelines are for successful care management execution. 1.     Patient Advocacy   Patients often find themselves lost in the intricate web of the healthcare system, unsure of what details are essential and when and how to share them. Care managers step in as advocates, guiding patients through this complex Care Management journey. For example, they may assist a nonverbal patient in obtaining a power chair for mobility, navigating the process from paperwork to communic

Managing medical records effectively is vital for providing top-notch patient care. Healthcare Data Platform has emerged as invaluable tools for healthcare providers, streamlining the process of handling vast amounts of data. These are thorough systems created to gather, organize, and store data from numerous sources. Further, these platforms are essential in today's data-driven healthcare landscape, where the volume of information generated daily is staggering. Let's examine these platforms' operations in more detail. Healthcare Data Platform: A Complete Solution Healthcare Data Aggregation: This platform is intended for Data Aggregation in Healthcare from a variety of sources, including wearable technologies, medical devices, and electronic health records. Structured and Unstructured Data: These platforms can handle both organized and unstructured data, including clinical notes and medical imaging as well as patient demographics and test res

The importance of Data Aggregation cannot be overstated enough in this technically advanced healthcare landscape.  Healthcare payers and providers are producing a record amount of data, with the sector contributing close to 30% of global data volume. Predictions suggest that by 2025, this figure will surge to 36%, surpassing other sectors like manufacturing, financial services, media, and entertainment. However, despite this data deluge, healthcare often struggles to utilize its full potential. The Data Conundrum One of the primary challenges in healthcare data management is that this vast pool of information is frequently segregated and disconnected across various systems. Only by combining healthcare data from all sources, clinical and non-clinical, can its entire worth be understood. However,  Data Aggregation in Healthcare is far from simple, mostly because there are no standards for data formats, there are strict rules, and there is an input of data from various source

One question arises regarding the healthcare landscape: Who gains the most from the  Risk Adjustment Solution   (RAS)? Is it the patients, who receive better-tailored care and improved health outcomes, or is it the healthcare providers, who can optimize their revenue through accurate and advanced technology integration? Let’s find out! What is a Risk Adjustment Solution?  RAS is a systematic approach used by healthcare units to analyze the health quality of their patient population. It involves identifying and coding patients' medical conditions, crucial for determining reimbursement levels from insurance providers like Medicare Advantage. The Role of HCC Coding HCC Coding  is a critical component of RAS. These codes indicate a patient's health complexity, influencing provider reimbursement. But who benefits most from this coding system? Key Benefits For Patients Patients benefit from the Risk Adjustment Solution in several ways: Improved Care RAS encourages thorough diagnosis