Benefit to Providers

Risk Adjustment Factor (RAF) ultimately allows us to gain a clearer understanding of the health status of our member population. As we accurately identify and code chronic conditions, our ability to map effective treatment plans improve, and our patients may become healthier as a result. The transition from volume to value-based care will lead to more cost-effective care and increase the accessibility to providers for our patients. 

Population Health Practice Liaisons

Population Health Practice Liaisons (PHPL) were established to help providers better understand ways to facilitate RAF and Proactive Care and implement the necessary initiatives at their practice.

Your PHPL will work with you regularly to identify key practice staff members—including at least one physician, one nurse and a performance improvement specialist—as points of contact in your practice. Your PHPL will help you to:

• Develop and implement RAF and Proactive Care workflows
• Establish a report distribution process and schedule
• Help you identify specialists with whom you can collaborate on closure of specific gaps in care
• Identify opportunities to provide education on RAF
• Identify ways to improve patient experience of care
• Patients’ needs and closure of gaps in care

Additionally, they will work to help implement Care Advising services to move toward closure of any care gaps.

Incentive

Practices will receive $150 per completed patient worksheet that is: 

• Complete with all the appropriate actions 
• Complete with diagnoses submitted on the claim 
• Faxed to the fax number on the bottom of the worksheet (faxes cut off or illegible will not be counted)

Incentives are paid on a quarterly basis to the tax ID of the practice, as are claims payments. Providers will receive a summary by email upon distribution.