DCA Dynamic Commerce Applications

RAP-Medicare™

Improve Medicare Risk Scores and Revenue

The Medicare Risk Adjustment and Revenue Challenge
	Medicare Advantage plans face major challenges ranging from rate reductions to surviving RADV audits
	CMS is significantly reducing the rating increases plans had anticipated
	Other rating adjustments have effectively made for significant rate decreases
	Continual increases in health care costs impact a plan’s financial performance
	Plans must continue to provide the highest quality of care and offer competitive benefit packages while navigating the rating and cost issues
	Plans need an efficient, proactive, and sound HCC management strategy or they risk losing members resulting in further financial problems
	Using DCA’s RAP Solution (Platform and on-going expert analysis) and committing to the execution of a sound HCC risk scoring strategy allows health plans to get the score/revenue they deserve as well as improve quality of care and financial performance

DCA's RAP infrastructure enables 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 those providers whose coding may be impacting the plan risk score
	Execute an integrated solution, both prospectively and retrospectively, for member outreach, provider outreach, RADV Audit, Chart Review, and Physical / Health Exam
	Efficiently and effectively respond to CMS RADV Audits
	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

RAP-Medicare™ 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 HCC management.
	RAP-Medicare™ supports Non-Drug, Drug and ESRD risk models, i.e. HCC, RxHCC, and ESRD. RAP-Medicare™ is for Medicare Advantage Organizations (MAO) including Medicare Advantage (MA) plans, MA-PD, and SNP.
	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, as well as specific files and reports generated by CMS to provide health plans the functionality needed to manage the risk adjustment process.
	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-Medicare outperforms internally developed solutions.
	The RAP platform is fully scalable allowing MA plans of all sizes to take advantage of its features. Additionally, because it is web-based, MA plans can access RAP anywhere they can access the web.
	The RAP platform’s algorithms assist plans in monitoring, targeting, tracking, and measuring their entire risk management program - both prospective and retrospective requirements.
	DCA’s experts continually work with plans using the RAP platform for revenue optimization strategies and specific best practices.
	Using DCA’s RAP services as the foundation of their risk management program allows plans to achieve effective risk score management, improved quality of care, and improved financial performance.
	Contact us to schedule a demonstration or for more information.

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