The Department of Health and Human Services found issues with health risk assessments used by Medicare Advantage insurers, leading to concerns about the accuracy of diagnoses and lack of treatment for serious conditions. Insurers earned significant payments based on diagnoses reported on home risk assessments (HRAs) alone, without other service records. The OIG report and a Wall Street Journal investigation highlighted the discrepancy between diagnoses made during HRAs and actual treatment provided. HRAs can provide valuable information on patients’ health but often lack organization and structure, leading to challenges in sharing information with care providers and impacting patient care. Clinically validated AI solutions offer a potential solution for improving care transitions and ensuring effective interventions and communication in healthcare.
Source link
How the Right AI Can Improve Health Risk Assessments
