Assessments
The Foundation for Appropriate Care Management
The INSPIRIS Assessments program is a targeted, multi-dimensional in-home evaluation that accurately reflects the health status of a member. A comprehensive clinical service with significant financial impact, the program is designed to meet CMS and state requirements for risk coding, clinical assessment, and regulatory compliance. Our prospective assessment is unique in that it is not only a risk-adjustment management solution but it also offers a health plan the unparalleled ability to address pertinent gaps in care delivery for members participating in the program.
Best Practice Clinical Knowledge Improves Quality and Optimizes Revenue!
The INSPIRIS provider (physician, nurse practitioner, or physician's assistant) visits the member at their residence to conduct a comprehensive medical evaluation that captures all of a member's health characteristics and provides a complete picture of their health status.
Our Targeted Visit Includes:
- A medical history review and analysis of available medical records
- Assessment of caregiver/family support
- Multi-dimensional needs assessment, with specific attention to physiological,
psychosocial, behavioral, functional and environmental needs - Diagnosis capture
- Encounter data and transmission via appropriate manner
A Focused Member Selection Process
INSPIRIS collaborates with the health plan to determine which members to target for
the Assessments program. Common criteria for member selection include:
- High probability of lapsed or under coding (based on claims analysis)
- Lack of PCP or healthcare system interaction for an extended period of time
- High-risk member based on risk score or past utilization
- New member to health plan
- Regulatory requirements
Unequivocal Benefits
Impressive ROI for both Clinical Quality and Financial Initiatives!
- Quickly establishes a risk profile of new members
- Reduction in amount of retrospective risk adjustment work
- Provides a measureable improvement in compensation
- Accurate resource planning as a result of personalized care
plan recommendations - Quantifiable return on investment
Through the Assessment program and the CarePlus SM program, INSPIRIS can drive appropriate revenue to ensure the highest level of care.