With the HEDIS® season almost over, health plans have another opportunity to examine opportunities for improvement. Over the years, health plans have learned that running successful Risk Adjustment and Quality Improvement programs means having a clear strategy for provider engagement. As 2021 continues to prove challenging with changing timelines due to the COVID-19 pandemic, how can health plans improve provider communication and engagement to start building an easier path to run their programs the second half of the year?

8741Achieving meaningful provider engagement requires an alignment between health plan and its providers with the unified goal of increasing quality of care for members.

Here are three steps health plans can follow to improve communication with their providers:

  • Communication Strategy. A well-orchestrated strategy considers the timeline but also provides both a full view and specific goals that need to be met every season.
  • Consistent & Accurate Outreach. Understanding provider preferences is extremely important to achieve effective communication, and to ensure consistency of message. The message can be extremely well crafted however if not consistent or delivered through the wrong channel it will fail. A vendor partner can assist in ensuring your provider preferences are up to date. Accuracy of your information is essential, if you are identifying potential care gaps for members within a physician’s practice, make sure that you are highly confident that you have thoroughly researched all available data sources before reporting the gap, even a single error in a gap report will erode the providers confidence in this activities ability to be helpful to them and their patients.
  • Actionable Information. Providing clear direction to providers is key. Offices usually have to serve requests from multiple health plans, and a clear call to action can make your communication stand out. Messaging around potential gaps in care should always reference the methods used to identify the gap and allow for the possibility that the gap is one of documentation and not in actual delivery of care. To that end all provider engagement activities around gaps in care should provide an easy and effective method for the physician’s office to provide documentation to demonstrate that the patient actually received the recommended care.

Health plans that consistently communicate with their providers, bringing them into the process and trusting them with information about the ultimate goals are more likely to obtain better outcomes.

Reveleer assists health plans with actionable insights around their provider base, including a provider score to identify providers that require special attention – including those with high volume sites for data acquisition.

Reveleer also offers a provider outreach module powered by Intelligent Automation, to reduce administrative burden and increase efficiency of provider calling.

Are you ready for the next half of the year? Give us a call and see how Reveleer can assist your Quality and Risk Adjustment programs in 2021. 

About The Author

Reveleer is a healthcare-focused, technology-driven workflow, data, and analytics company that uses natural language processing (NLP) and artificial intelligence (AI) to empower health plans and risk-bearing providers with control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform allows plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services, so health plans can confidently plan and execute programs that deliver more value and improved outcomes. To learn more about Reveleer, please visit Reveleer.com.