Case Study

The New Age of Risk Adjustment

The New Age of Risk Adjustment

As pandemic-driven economic instability proliferates and exacerbates pre-pandemic challenges in the U.S. healthcare system, health plans must act quickly to address member healthcare needs, collect data to effectively treat at-risk populations, and accurately document risk scores. Failure to do so not only puts more people at risk for catastrophic health costs but puts health plans at risk to not receive appropriate premium revenue or compensation to cover medical costs for their members. To address these new realities, payers must accelerate the development of a cohesive approach to risk adjustment. Implementing a holistic strategy can help improve risk scores, leading to more accurate reimbursement and better-quality performance. Developing and implementing such a strategy b

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