SANTA ANA, Calif.--(BUSINESS WIRE)-- Advantmed, LLC, an integrated risk-adjustment optimization and quality improvement company, today released its white paper, “Rise of Medicare Advantage Plans and its Implications for Risk-Bearing Healthcare Providers,” the second in a three-part series, “High Priorities for the U.S. Healthcare System: Powerful End-to-End Solution to Integrate Patient Care.” Developed to support Medicare Advantage (MA) plans in their quest for innovative approaches to improve patient care, this paper examines trends driving the growing adoption of MA plans, provider opportunities and challenges in the increasingly value-based healthcare system, and innovative strategies for risk adjustment, quality and care management.

“The proposed rule issued by the Center for Medicare & Medicaid Services (CMS) shrinks the amount of time accountable care organizations (ACOs) can be in an upside-only model to two years – with 82 percent of ACOs currently participating in the MSSP in an upside-only model,” says Jay Baker, senior vice president, quality and risk adjustment solutions, Advantmed. “In this environment, provider success in value-based care and reimbursement pivots around delivering on total patient health, cost and quality rather than relying on value units, revenue and downstream referrals.”

Practices that make the shift from fee-for-service to managing risk are able to increase their practice profitability by at least 25 percent. To gain a robust view of members and their care needs, providers can rely on Advantmed’s Prospective Health Assessments (PHA) to develop more accurate reporting documentation, improve patient engagement and compliance, enhance disease management and reduce utilization. PHAs provide a full-spectrum, end-to-end approach to help providers identify gaps in care and manage patients more productively.

“The greatest benefit goes to the patient, who will be guided toward preventive care and self-management early in the care process,” Baker adds. “Advantmed offers a tailored suite of integrated risk adjustment and quality improvement services that meet the needs of a value-based payment system.”

About Advantmed, LLC

Advantmed, LLC is a healthcare solutions company dedicated to partnering with health plans, provider groups and risk-bearing entities to optimize risk adjustment and quality improvement programs. Our integrated and technology-enabled solutions improve health plan financial results and offer insights on health plan members. For more information on Advantmed’s solutions visit www.advantmed.com.

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