Inovalon Holdings Inc.

04/12/2024 | Press release | Distributed by Public on 04/13/2024 06:47

From Insight to Action: Lessons Learned at RISE National 2024

RISE National 2024, a stage for building trust

One of the biggest themes at RISE National 2024 was the need to cultivate trust through a culture of compliance. This trust has to manifest in a few different ways and areas of healthcare. Recent security breaches and the Department of Justice's (DOJ) pleas to health plans to create trustworthy Medicare ecosystems highlighted just how necessary trust is moving forward.

Although RISE is known for its focus on risk adjustment, this year took an innovative turn by integrating sessions focused on quality as well. This shift was evident in Nashville, amid an unprecedented presence of quality leadership. The discussions ranged from the immediate challenges posed by the latest security incidents to the evolving landscape of quality and star ratings, underscoring the need for a holistic approach to healthcare quality and risk management.

The quest for quality amidst uncertainty

The latest data compromises have sent shockwaves throughout the healthcare ecosystem, as evidenced by large organizations undertaking extensive electronic health record pulls to mitigate data collection challenges. This situation has sparked a broader discussion on the security stance of plans and vendors.

Conversations at RISE National 2024 raised critical questions about disaster recovery strategies and the viability of having a backup HEDIS® vendor despite the associated costs.

Medicare Advantage (MA) star ratings: a call for precision and equity

The discourse on MA star ratings highlighted the absence of cut-point forecasting in quality improvement solutions. Additionally, the focus on CAHPS performance and the consequential effects of survey methodology on star ratings emphasized the intricate challenges of quality improvement.

The conversation also ventured into the significance of the Health Equity Index reward factor, illustrating a growing awareness of the need for inclusivity in quality assessment.

Bridging the gap: quality and risk integration

An intriguing aspect of the conference was the exploration of opportunities for quality and risk teams to collaborate. Despite the hurdles posed by organizational silos, there's a clear consensus on the benefits of integrating these teams, particularly in terms of member and provider outreach.

An integrated approach to quality and risk allows health plans to:

  • Transform operations with a unified analytics program
  • Enhance outcomes and member satisfaction through seamless information sharing
  • Lessen burnout and build successful health plan and provider relationships

Looking forward: strategy and integration

RISE National 2024 marked a pivotal moment in the convergence of quality and risk, highlighting the urgent need to dismantle existing silos. As we navigate the complexities of healthcare quality and risk management, the insights from Nashville offer a roadmap for a more integrated, resilient future.

The path forward involves a steadfast commitment to thoughtful and integrated approaches to quality, risk, member outreach, and ensuring the member is always at the center of strategic decisions.

The journey ahead is one of collective effort and shared vision, aiming for a healthcare system that embodies trust at every level.

Learn more about converging your quality and risk efforts with Inovalon's Healthcare Payer Solutions.

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