COVID-19 Created Challenges For Risk Adjustment Solution
The health industry suffered major disruptions and setbacks as the COVID-19 crisis hit all areas of the healthcare industry. The pandemic created unexpected challenges for health plan risk adjustment (RA) methods and care providers working under the RA model. The overall mechanism of risk adjustment solutions for health plans is affected by the following three important developments: 1.
The reconstruction of patient charts annually is a necessity for healthcare plans. As the public healthcare system rapidly switched to critical medical services to create room for COVID-19 patients, nonessential staff stopped maintaining patient's medical history and clinical charts.
2.
Patients’ visits fell drastically as hospitals prepared themselves to serve the high volume of COVID-19 patients and other emergency cases with life and death situations. Resultantly, this pushed the annual health checkups as well as chronic care appointments towards the end of the year.
3.
The ‘’shelter-in-place’’ orders instruct in-house healthcare providers and administration to shift to remote or virtual services. Manual charts are now difficult to recreate due to confidentiality concerns. This needs
effective data management tools. Health plans are therefore compelled to reconsider risk adjustment solutions and put new strategies into practice. How to Meet Risk Adjustment Challenges Amid COVID-19? As healthcare plans gear up to run risk adjustment solutions smoothly, the following actions must be taken to ensure high productivity and effectiveness: 1. COVID-19 is making social determinants of health (SDoH) significantly worse since more people are experiencing social isolation, anxiety, food insecurity, and residential uncertainty. To meet these challenges of medical care, SDoH must be explored more widely. 2. The care gaps highlighted earlier will remain unresolved until Electronic Medical Records are improved for easier tracking. 3. There should be a system for health plans that can combine inhouse and remote or virtual HCC coding in a hybrid algorithm. It should ensure the safety of sensitive patient data. 4. A software is needed to automatically extract data from EMRs to accurately retrieve charts in the absence of analog charts. 5. Simplify workflow and foster team-wide cooperation initiatives to ensure HCC coding accuracy. 6. The accuracy of risk adjustment scores can be achieved by adopting AI-based software capable of suggesting accurate codes and adjustments. 7. Incorporate telehealth training along with coding and reporting criteria for care providers. Conclusion To work effectively, providers must have the knowledge and tools to continue providing high-quality work. It will help them to keep the Risk Adjustment process running smoothly. Health plans must develop innovative risk adjustment solutions for identifying real data points instead of concentrating on dubious findings from limited and inaccurate algorithms.