If you want to implement value-based care, you need to define what a ‘good’ outcome is. A good outcome may be different for different individuals. For instance, if you look at mortality rates for a given disease, it makes sense that individuals age 80 and… Read More »Should you risk adjust for social factors?
Health plans complete in-home health assessments (often called health risk assessments) for their members for several reasons: accurately documenting members’ risk burden, supporting care management initiatives, and improving member engagement with the health plan, to name a few. But plans that don’t optimize their in-home… Read More »How to turn in-home assessments into “close encounters of the right kind”
The Centers for Medicare & Medicaid Services (CMS) recently released the health plan-specific 2019 benefit year risk adjustment transfer payments. As part of the Affordable Care Act (ACA), these payments move money from health plans that serve healthier populations to those with sicker members. Based… Read More »CMS releases ACA risk adjustment transfer payments and HRADV adjustments for 2019
As routine medical services are cancelled or postponed due to COVID-19, prospective risk scores used to pay Medicare Advantage (MA) health plans in 2021 are trending lower than forecasted. Additionally, risk scores for the Health and Human Services (HHS) model used by the Affordable Care… Read More »Mitigating the impact of COVID-19 on risk adjustment and quality scores
The core of a successful risk adjustment program is fully understanding your members as well as the various data exchanges that take place along the risk adjustment continuum. But the COVID-19 pandemic has introduced new challenges to optimizing risk adjustment revenues while maintaining compliance. Read… Read More »Laying the foundation for commercial risk adjustment success amid COVID-19