The U.S. healthcare system is in the midst of a seismic shift from a fee-for-service reimbursement model to a value-based one. Risk adjustment is used by the Centers for Medicare and Medicaid Services (CMS) to set benchmark payments for Medicare Advantage, Commercial Exchanges, Medicare Shared Savings and many other programs.
For healthcare organizations currently taking on risk or looking to take on risk for these populations, it is critical for them to understand and accurately manage risk adjustment.
Excelling at risk adjustment requires providers to leverage patient data and innovative data analytics strategies and tools to improve clinical documentation, coding best practices, and overall care planning. This white paper outlines:
- The current state of healthcare risk adjustment
- Risk adjustment challenges facing provider organizations and accountable care organizations
- Six steps to succeeding at risk adjustment