Risk adjustment has been used for years by health plans to reflect the expected cost of providing coverage for their members. Today, it’s also as an important price stabilization features of the Affordable Care Act (and Medicaid Managed Care and Medicaid Advantage).
But risk adjustment models are complex and rely on the accurate and timely exchange of data. Many health plans lack the internal processes and systems necessary to do this. This leads to unhappy provider networks, which bear the brunt of manual data collection, and the potential costs associated with RADV audits.
To better understand the challenges and opportunities health plans face, download the free Availity white paper, Risk Adjustment: A Roadmap to Success. You’ll learn:
The role risk adjustment plays in the transition to value-based care models
Why existing systems and processes prevent accurate data capture
How digital tools are helping health plans improve data capture workflows