Virtual Risk Adjustment
A telehealth-based solution for risk adjustment visits enables continuity of care and improves ROI
Risk adjustment is essential to health plans as it determines how much they will be paid – especially for Medicare Advantage and Exchange plans and increasingly Managed Medicaid. Each year, health plan members must have their health status up-to-date and documented correctly in order for the health plan to be accurately reimbursed for the health risk of their membership.
However, as risk adjustment typically relies on a member’s in-person visit to a doctor’s office or an in-home visit by a clinician sponsored by a health plan, COVID-19 dangers and related social distancing requirements present significant challenges to traditional risk adjustment programs. Fortunately, as in other parts of healthcare, the approved expanded use of telehealth by the Centers for Medicare and Medicaid Services (CMS) has provided a solution, as risk adjustment is one of the services CMS allowed to be provided remotely by telehealth.
For a virtual risk adjustment visit to meet the CMS requirements, the visit need to occur via an interactive audio and video telecommunications system that permits real-time interactive communication. However, research has shown 30-40% of targeted health plan members lack the basic technology and/or connectivity to perform a qualified virtual risk adjustment visit under the CMS requirements. Sano Health provides a telehealth enablement solution ideally suited to solve this problem.
Working closely with health plan partners, Sano Health can ship an activated, ready-to-use telehealth device (handheld/tablet) screen, configured for the unique needs of each health plan, directly to in-need and under-connected members. The Sano device is “locked” and can only be used for authorized telehealth-related activities approved by the health plan and is preloaded with only needed and authorized applications to make it easy for the member to navigate and use. Additionally, the Sano device includes sufficient mobile data for approved uses – such as a virtual risk adjustment visit. Sano devices operates on all the “Big 3” wireless networks along with key regional wireless networks to reach a health plan’s most remote members. Sano Health provides its solutions to members on either a permanent, semi-permanent (<12 months) or “single use” basis depending on health plan needs.
To learn more about Sano Health and our payor-focused telehealth solutions, please visit: https://www.sanohealth.com/services/health-plans
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