A 3% Annual RAF Improvement isn’t Nearly Enough.
Depending on the individual risk sharing arrangement, CMS will cap annual risk score improvement to a 3% RAF lift over the benchmark for a population. This can lead to a very common assumption, that 3% can be used as an obvious, un-nuanced goal for risk adjustment strategy each year. Unfortunately, this is incorrect. Fortunately, we’re […]
MA Deadline Extensions for 21-22: CMS Policy Update and Strategy Guidance
Earlier this year, we discussed the final call letter from CMS detailing the Medicare Advantage (MA) deadline extensions for PY 2020 (i.e. 2019 dates of service) to account for COVID-19 related disruptions. We suspected, but had no confirmation at the time, that this would continue going forward. While CMS hasn’t made any public announcements, we […]
Medical Loss Ratio and COVID-19: Investment, Risk, and Looking through 2022
For payors, Medical Loss Ratio is down to a point of short-term crisis and long-term complication this year and next. However, there is a solution: payer investment in pre-encounter programs that drive quality and care.
Strategies for Different Patient Populations and Payment Models
One-size doesn't fit all when it comes to the underlying risk adjustment strategies health plans should pursue given the market(s) that they participate in.
Tag: Medicare Advantage
Medicare Advantage (MA) Health Plans
Medicare Advantage (MA) health plans receive risk-adjusted reimbursements directly from the Centers for Medicare & Medicaid Services (CMS). There is no risk pool or transfer payments. The financial impact of risk adjustment in the MA market is significantly greater given that risk conditions are much more prevalent in elderly patients.