Increased regulatory scrutiny calls for accuracy and PCP involvement in risk adjustment programs

Risk adjustment

Over the past several years, there has been a noticeable uptick of claims against Medicare Advantage Organizations (MAOs) centering around what the government alleges are aggressive initiatives focused on boosting risk scores and associated payments.

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Key metrics for value-based care

Value-based care (VBC) is designed to incentivize providers to improve outcomes in a cost-efficient manner. In other words, payment and quality of care are inextricably linked.

What’s behind the move from retrospective to prospective risk adjustment?

Health plans across the country are recognizing the superior value of prospective risk adjustment programs, and rightfully so.

Another blow to detached health risk assessments

Health Affairs recently published a study of data from 4 million Medicare Advantage (MA) members indicating that health risk assessments (HRAs) contributed up to $12 billion per year to risk adjusted payments in 2020.

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Talk to one of our risk adjustment experts today to see how we can help you deliver better performance and stronger compliance while closing gaps in care.

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