How do we solve this problem?
MSure has found potential overpayment of $80M in just one state (FL) and around $14M in ER visits for a large health plan in the first quarter of 2020.
In the “capability to assess business impact due to policy changes” space, HiLabs offers MVision, a what-if-analysis capability that executes impact analysis and gives production advisory. The tool gives the flexibility to try-out various options of HCC modeling, powerful and scalable "what-if" analysis capabilities and also an accelerator to build big data (Hadoop/Spark) based RASS for CMS. With this tool, users can identify average impact on RAF score (and associated dollar amount), visualize impacts, identify net scoring of HCCs and carry out impact analysis at beneficiary level.