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DST Health Solutions Launches New RiskAnalyzer Software to Help Medicare Advantage Plans Manage Risk Adjustment
Date:2/19/2009

RiskAnalyzer Incorporates Johns Hopkins ACG System for Provider Profiling, Predictive Modeling, Resource Management and Rate Adjustment

BIRMINGHAM, Ala., Feb. 19 /PRNewswire/ -- DST Health Solutions today announced the launch of its new Medicare risk adjustment software, DSTHS RiskAnalyzer(TM). RiskAnalyzer uses claims experience to determine where provider coding is not capturing disease conditions under the Centers for Medicare and Medicaid Services Hierarchical Conditions Category (CMS-HCC) model. It provides an objective set of rules to prioritize provider and member records for chart audit through identification of potentially incomplete or inaccurate patterns of coding -- either retrospectively or prospectively.

RiskAnalyzer is part of DST Health Solutions' CareAnalyzer(TM) analytics solution, which helps health plans identify high-risk members for care management. RiskAnalyzer and CareAnalyzer support appropriate member management with integrated report views of cost, quality and risk.

"In 2007, CMS completed the phase-in of risk-adjusted payments for Medicare Advantage plans based on the CMS-HCC model," said Amy Salls, Business Solutions Director for Decision Support, DST Health Solutions. "The goal of risk adjustment was to pay Medicare Advantage plans based not only on member demographics, but also on health status. This means that plans with the most effective risk adjustment optimization programs will have revenue that more accurately reflects their true risk."

RiskAnalyzer is designed to help health plans evaluate claims based on the likelihood of missed diagnosis codes. The software can also help plans identify mid-year variances while there is still an opportunity to appropriately document member risk factors.

RiskAnalyzer incorporates the ACG System, a peer reviewed methodology for provider profiling, predictive modeling, resource manage
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SOURCE DST Health Solutions
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