In-Home Assessments

Ensure member conditions are accurately documented and coded to optimize plan revenues while closing care gaps

The facts

To fully manage and coordinate the care of their members, health plans need access to all pertinent member medical data. Too often, however, the information contained in medical records, claims, or encounter data does not represent the full scope of a member's health, social conditions, or behavioral health insights. Having qualified nurse practitioners or physician assistants reach members in their homes and complete comprehensive in-person health assessments can provide essential and missing clinical data. Not only can this process drive quality and care management initiatives, it can also provide appropriate and comprehensive documentation to ensure members’ clinical risk burden is appropriately captured and substantiated for risk adjustment purposes.  

Cotiviti’s In-Home Assessments solution supports member assessments in a home or alternative provider setting through a nationwide network of local nurse practitioners and physician assistants, helping improve prospective risk adjustment results and close care gaps.

Benefits

Ensure medical documentation is appropriate and complete

Improve risk score accuracy, and enable recognition of incremental risk-adjusted revenue

Have a positive impact on additional quality metrics with point-of-care testing

Connect members with their providers to proactively assess health status and close gaps in care

Multi-channel member engagement for better results

Our approach begins with member engagement. We use a wide variety of communications, including mail, phone, text, and email to schedule appointments, then send reminders to ensure members don’t miss their appointments. Our outreach scripts are carefully crafted in consultation with our clients. We also have members take a follow-up satisfaction survey to ensure the quality of our services.

 

In-home assessments conducted by qualified nurse practitioners and physician assistants

Our experienced professionals conduct Centers for Medicare & Medicaid Services (CMS) compliant, multi-dimensional needs assessments to close gaps in care and ensure accurate documentation of members’ health conditions. In addition to supporting risk adjustment, this assessment also directly affects quality measures to improve Star Ratings and HEDIS® scores.

 

Rapid results communication

After health assessments are complete, we quickly move forward with coding, communicate with the members’ confirmed primary care physician (PCP) to support ongoing care, and communicate directly with the member to facilitate discussion with his or her PCP. We deliver weekly reports of members who are targeted, contacted, or scheduled to keep our clients apprised of their status.

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

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Results that speak for themselves

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