By RaeAnn Grossman
In the late 1990s, I was part of an extraordinary team that managed the percentage of premium risk for over 450,000 lives in Arizona. We did it all from credentialing to care management to claims payment. We had our physicians in aggressive incentive programs which offered engagement and care plan alignment. These same concepts hold true today.
When I think about what makes risk sharing or even gain sharing successful, there are the 4 Cs.
- Culture of Engagement: Physicians, health systems, and ancillary providers are willing to learn and move toward one another in care alignment.
- Common Metrics: Providers have to manage their performance across different payers and populations in similar manners, such as select HEDIS or STARS metrics or risk adjustment tactics.
- Consumable Insights: Touchpoints at the point-of-care to help navigate referral networks, social needs, quality gaps, and risk adjustment specificity.
- Credible Reporting: Nothing will end a conversation more quickly than an error in a report you are reviewing with a physician or health system. Reports need to be visual and clear on impacts and alerts.
At DataLink, we manage over 7 million lives in Medicare Advantage, Medicaid, and Commercial around clinical, quality, and risk performance strategies and outcomes. We understand the culture of engagement, create common metrics to manage across payers and populations, share consumable insights so each visit is as impactful as possible, and we analyze success with credible reporting. Our work makes our medical groups, MSOs, hospitalists, in-home care providers, and health plans more insightful, more prepared, and yield better health outcomes because we embrace the 4 Cs of managing risk.