Matrix Medical Network Study Demonstrates Value of Year-Round Prospective Assessment Programs

Medicare Advantage Plans Realize Return on Investment; Members Experience Positive Health Benefits

SCOTTSDALE, Ariz.--(BUSINESS WIRE)--Matrix Medical Network, a national leader in prospective medical assessment services for Medicare Advantage plan members, has released the results of a study that demonstrates the positive impact of conducting year-round prospective assessment programs (versus second-half-of-year-only programs) for Medicare Advantage plans and members.

“Matrix clients received the highest quality risk assessments for their members which in turn drove positive financial impact and additional value for the client in the form of reduced medical expenses, greater medical management integration, improved member retention, and better audit protection”

The evaluation of client data over an extended period indicates that year-round prospective assessments conducted by Matrix-employed clinical professionals generated a significant Return on Investment (ROI) for Medicare Advantage plans. Furthermore, the year-round program using specially trained employee clinical professionals, rather than temporary, agency or otherwise non-permanent staff, had a positive impact on the health of members. This health benefit was achieved through higher quality assessments enabled by assessment repetition, assessment and coding consistency, and the ongoing training and development of clinical professionals conducting the assessments.

“Matrix clients received the highest quality risk assessments for their members which in turn drove positive financial impact and additional value for the client in the form of reduced medical expenses, greater medical management integration, improved member retention, and better audit protection,” said Brian Esterly, Matrix’s senior vice president of operations. “Year-round assessments conducted by a highly-trained, employee clinical team have a demonstrated impact on a plan’s ability to substantiate submission of additional codes for proper reimbursement and have a very positive impact on the overall health of and care received by a plan’s members.”

Key findings include:

• Year-round assessments conducted by Matrix-employed clinical employees generate a significant ROI through quantifiable reductions in medical expenses and earlier recognition of revenue.
• Increases in member retention among those participating in the assessment program (an approximate 46 percent increase in retention).
• Mitigation of audit exposure by ensuring that codes submitted are substantiated.
• A year-round assessment program conducted by employee clinical professionals led to stronger satisfaction ratings for the 5-Star Ratings’ CAHPS and HOS surveys.
• The Matrix assessment is a valuable tool to capture HEDIS measurements because second-half-of-year-only program measurements are not being collected during the HEDIS audit period.
• There is greater access to plan members residing in medical facilities because of the familiarity and comfort created between Matrix’s clinical staff and facility administrators.
• Second-half-of-year programs reduce the opportunity for annual assessments because these programs generate fewer member encounter opportunities. Summer schedules, winter holidays, and the impact of the cold and flu season all limit the number of available assessment days, a scheduling challenge that is reduced by implementing a year-round assessment program.

For additional information and a copy of the study, contact [e-mail].