Transforming risk adjustment performance with Reveleer Care Gap Manager
Business challenge
A multi-state Medicare Advantage payer serving approximately 100,000 members faced persistent challenges in risk adjustment, including delayed HCC submissions, poor provider engagement, outdated communication methods, and frequent missed deadlines.
These operational barriers led to frustration among provider partners, missing supplemental data, consistently low Star Ratings (3.0–3.5), and ultimately limited the health plan’s revenue, accuracy, and competitiveness.
Driving operational excellence through transformed provider engagement and care gap closure
Reveleer partnered closely with the health plan to develop a comprehensive, three-part strategy targeting their most pressing operational challenges. First, they established a provider-facing Medicare Advantage Quality Incentive Program (QIP) with an Early Bird HCC submission deadline, motivating provider groups to submit gap closure evidence early and maximize revenue potential during the critical September sweep.
To support this, the health plan enhanced backend workflows and IT systems by upgrading HCC processing and tracking for timely, accurate closure of persistent and suspected gaps. At the same time, Reveleer’s Care Gap Manager was implemented to give providers real-time, year-round visibility into member rosters and care gaps, streamlining supplemental data submission and ensuring compliance.
Interactive dashboards displayed current incentive earnings and QIP progress, keeping all stakeholders aligned. By leveraging multi-channel communications and clear calls to action, Reveleer enabled strong engagement across both large provider groups and the long tail of smaller practices, driving smoother workflows and improved outcomes for all.
Driving sustainable growth and quality performance
Following the successful implementation of Reveleer’s Care Gap Manager, the regional health plan transformed its ability to close care gaps, engage providers, and capture revenue more effectively. With measurable gains in revenue, provider satisfaction, and operational efficiency, the organization now has a proven foundation for long-term growth, competitive Star Ratings, and ongoing quality improvement.
Next steps: Continue building advancing performance and growth with Reveleer
Looking ahead, the regional health plan aims to extend the impact of Reveleer’s Care Gap Manager by expanding care gap and quality improvement practices to more plans and members. Their plans include leveraging advanced analytics for targeted interventions, enhancing provider education for early and accurate HCC submissions, and regularly monitoring performance metrics to proactively address challenges. By exploring further automation of backend processes, the organization remains committed to continuous improvement, driving sustained revenue growth, higher quality outcomes, and stronger provider engagement.
Related Resources
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