What Is Risk Adjustment and How Is It Accomplished Under MA: A Conversation with Robert Book (May 13th)
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Listen Now Risk adjustment is a statistical method by which payers can reasonably predict how much a patient's care needs are expected to cost in any given year. In so called Fee-For-Service Medicare this matter is essentially moot since since providers are simply paid for the reimbursable services they provide their patients. However, health care payment is rapidly moving towards fixed or pre-arranged reimbursement models. For example, Medicare Advantage plans are paid a pre-determined or fixed per member per month fee and ACOs are incented to spend less annually than a pre-determined benchmark that amounts to an ACO's patients' historical costs risk adjusted. Therefore, risk adjustment, or getting risk adjustment right, becomes critically important.
What Is Risk Adjustment and How Is It Accomplished Under MA: A Conversation with Robert Book (May 13th)
What Is Risk Adjustment and How Is It…
What Is Risk Adjustment and How Is It Accomplished Under MA: A Conversation with Robert Book (May 13th)
Listen Now Risk adjustment is a statistical method by which payers can reasonably predict how much a patient's care needs are expected to cost in any given year. In so called Fee-For-Service Medicare this matter is essentially moot since since providers are simply paid for the reimbursable services they provide their patients. However, health care payment is rapidly moving towards fixed or pre-arranged reimbursement models. For example, Medicare Advantage plans are paid a pre-determined or fixed per member per month fee and ACOs are incented to spend less annually than a pre-determined benchmark that amounts to an ACO's patients' historical costs risk adjusted. Therefore, risk adjustment, or getting risk adjustment right, becomes critically important.