What is HCC Coding in Risk Adjustment?
Despite the pivotal role value-based care has in healthcare in the United States, it’s often not well understood. In the same spirit in which we covered the basics of risk adjustment and two-sided risk, today we want to tackle HCC coding in risk adjustment. With any luck, you’ll come away with a better understanding of […]
What is two-sided healthcare risk?
Depending on your role at a health plan or risk bearing health system, you’re aware of value-based care (VBC) models. However, depending on the model itself (and sometimes within the same model of value-based care), there can be different variations of two-sided healthcare risk, also known as upside and downside. An organization’s level of engagement […]
2021: The Year of Optimized Risk Adjustment
Calling 2020 disruptive to healthcare is an understatement. But 2021 offers some unique opportunities to become a year of optimized risk adjustment. With the signing of the American Rescue Plan Act of 2021, barriers and premiums for COBRA have been reduced or eliminated, there are new Medicaid expansion incentives, and the ACA marketplace has an […]
ACA Risk Adjustment: A Competitive Advantage
With the Biden administration re-opening the ACA exchange and the impacts of COVID-19 on employment through 2020 and beyond, we want to address the impact of ACA risk adjustment. The expanding healthcare landscape under the ACA and the continuous shift to value-based care means effective risk adjustment is often the difference between profitability and losses […]
What is Risk Adjustment in Healthcare?
Risk adjustment is a critical part of both the financial and clinical aspects of healthcare in the United States. Still, even many people working in healthcare don’t really understand what it is, why it’s important, or how it works. First, what is risk adjustment? Healthcare for approximately 110 million Americans is provided by the US […]
Medicaid Risk Adjustment: Even if Your State’s Medicaid Hasn’t Expanded, Your Risk Adjustment Strategy Should
Managing Medicaid risk adjustment is almost never a top priority. State by state regulations differ, making it complicated and costly to perform, and it is not often financially worth the trouble. Medicaid risk adjustment is effectively budget neutral, in that the funding is a fixed pool, apportioning dollars between organizations covering those lives based on […]
HCC Recapture is Critical, HCC Recapture is Never Enough
Recently, we discussed the imperative of HCC recapture, especially in a year with encounter volumes heavily disrupted by COVID-19. However, HCC recapture is only a small part of the larger goal: discerning a complete and accurate risk profile of a covered population. With an accurate risk score, reimbursement can match the total cost of necessary […]
Flattening the Other Curve: Using Risk Adjustment to Manage Rebounding Patient Volumes
As care patterns continue to shift, and we see new utilization patterns, the stability of capitation and the revenue insulation provided by thorough, effective risk adjustment are key to thriving during uncertain times.
3 Takeaways to Look for at RISE West
If compliance is a key priority for your organization, we’ve put together a brief “playbook” of the areas we recommend you explore during your 2017 RISE West Summit trip.