Business Challenge

Our client is an award‐winning Independent Physician Association located in Northern California. As the healthcare industry shifts away from the fee‐ for‐service payment model, our client’s top priority is to more closely align with the movement towards alternative payment models, such as Medicare Advantage (MA) Risk Adjustment Factor (RAF) reimbursement.

The key issues that faced our client were:

  • A lack of insight and resolution into encounter data integrity issues occurring at each phase of the encounter data lifecycle.
  • Multiple unmanaged vendors supporting the RAF program with unmeasured outcomes and lack of cross‐department coordination.
  • Several analytics systems producing conflicting risk score information, with no agreement as to the ‘source of truth’.
  • Misalignment between physician network reimbursement incentives and RAF score improvement.
  • RAF program ownership and operations buried within a small department creating low organizational visibility, empowerment and organizational commitment.

Client & Engagement Quick Facts

  • Client has a provider network of over 1,500 physicians, spanning across 40 cities and serving more than 300,000 patients.
  • Eight‐month project duration, beginning with current state discovery and finishing with detailed recommendations, some of which we implemented, monitored and refined.
  • Presented project findings, analysis, recommendations, ROI and improved operational outcomes across four leadership meetings.

Our Solution

Through our discovery process, we identified RAF program failure points, provided prioritized solutions (based on expected ROI), work plans to implement solutions and managed several solutions to operational readiness and monitoring. We implemented a single vendor solution to perform high‐quality Annual Wellness Visits (AWV), including a timely audit and feedback loop. We served in an interim management position and provided business ownership as well as project management support to implement a risk management analytics system.

Business Benefits

Our client continues to use our RAF Program improvement recommendations to implement additional solutions, monitor the change and make refinements to improve their RAF score.

About Kenny & Company

Kenny & Company is an independent management consulting firm providing Strategy, Operations and Technology consulting services to our clients. Our management consulting practice, experience and insight also enable us to provide early stage venture capital investments to select startup companies, and through our philanthropic endeavors to give back to our communities.