DCA Dynamic Commerce Applications

RAP-Medicaid™

Improve Medicaid Risk Scores and Revenue

DCA provides RAP infrastructure for enabling Medicare health plans to:
	Proactively & consistently monitor risk score to get the revenue they deserve
	Prospectively identify and outreach to specific members who significantly impact the plan risk score
	Identify specific providers whose coding may be impacting the plan risk score
	Enable the targeted providers to submit complete diagnostic data (essential in risk scoring) on a consistent basis for both Prospective and Retrospective risk scores
	Use risk based analytics for disease/case management, provider profiling and contracting, P4P programs, and medical underwriting
	Achieve the fastest, most practical, and efficient outcomes for risk score management (consistently improving risk score) with significant ROI

The Medicaid Risk Adjustment and Revenue Challenge
	Medicaid Managed Care health plans face significant issues concerning revenue as many states are having budgetary problems resulting in rating decreases
	Continual increases in health care costs impact plan financial performance
	Plans must continue to provide the highest quality of care while navigating rating and cost issues
	In states where risk adjustment has been implemented, plans must effectively manage risk adjustment processes or risk further financial problems
	Using DCA’s RAP Platform and committing to the execution of a sound risk adjustment strategy allows health plans to improve both quality of care and financial performance

RAP-Medicaid™ is an advanced Revenue Management Service

	DCA’s RAP subscription-based service consists of RAP Infrastructure and on-going Expert Analysis for revenue optimization and best practices for revenue management.
	RAP-Medicaid™ supports the various risk models implemented by state Medicaid agencies (CDPS, CDPS+Rx, MRX, ACG, CRG, and DCG) and is customized to support state specifications giving plans the tools to proactively manage the risk adjustment process.
	The RAP infrastructure is a web-based service hosted and maintained by DCA with almost no burden to the plan’s IT department. Clients provide historical data initially, then data files in simple formats on a regular basis. RAP algorithms use this data to provide health plans the functionality needed to manage the risk adjustment process.
	The on-going RAP Expert Analysis for revenue optimization and best practices include areas such as determining plan specific Provider/Member intervention strategy, identifying the type and number of in-house resources needed for executing the strategy, conducting workshop sessions, and tuning the action plan on an on-going basis.
	DCA has implemented RAP services in just 4 weeks for many of its clients, giving MA plans the solution they need quickly and efficiently. With its advanced features along with on-going expert analysis, RAP-Medicaid outperforms internally developed solutions.
	The RAP Infrastructure is fully scalable allowing plans of all sizes to take advantage of its features. Additionally, because it is web-based, plans can access the system anywhere they can access the web.
	RAP Infrastructure algorithms assist plans in monitoring, targeting, tracking, and measuring their entire risk management program - both prospective and retrospective strategies.
	DCA experts continually work with plans using the RAP platform for revenue optimization strategies and specific best practices.
	The revenue improvements of our clients have been in the millions of dollars - even in those states that Risk Adjusted Payments are based on a budget neutral model.
	Also, if a Medicaid Plan needs help with their Encounter Reporting, they could use DCA’s Encounter Reporting Infrastructure (ERI) or its consulting services.
	Contact us to schedule a demonstration or for more information.

© 2011 Dynamic Commerce Applications, Inc.

All Rights Reserved.