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Prospective Risk Adjustment: Clinical data that drives revenue and strategy

In 2020, many patients deferred healthcare utilization which created gaps in care and a significant drop in claims volume. One solution for proactively re-engaging members with the healthcare delivery system and accurately documenting disease burden is In-Home Assessments (IHAs). However, a recently published Office of Inspector General (OIG) report asked whether IHAs were being used to actually improve patient care or simply as a way for health plans to increase risk-related payments.

Our webinar draws on a study of completed IHAs for Medicare Advantage (MA) members to answer that question. Our analysis revealed that members did experience meaningful follow-up encounters with a primary care physician (PCP) as a means to re-engage with the healthcare delivery system. The data also showed that health plans benefit from completed IHAs by improving condition documentation.

In this presentation, risk adjustment leaders from Cotiviti and Fallon Health discuss the analysis of IHAs and provide attendees a better understanding of how:

  • A completed In-Home Assessment (IHA) positively impacts member engagement
  • Health plans target the right members that would benefit from an IHA
  • Clinicians that deliver IHAs serve as an important conduit between patient and provider

Learn more by accessing our on-demand webinar.


Stacy Coggeshall, Fallon Health

Stacy Coggeshall
VP, Risk Adjustment, Fallon Health

David Costello, Cotiviti

David Costello
SVP, Risk Adjustment and Innovation, Cotiviti