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Risk Adjustment in Healthcare: Essentials Every Provider Should Know (Co-Authored with Nuance)

Risk Adjustment in Healthcare: Essentials Every Provider Should Know (Co-Authored with Nuance)

  • January 31, 2019

Most healthcare providers have not been intimately involved or even aware of the risk adjustment methodologies used in common Pay-for-Performance risk contracts, such as Medicare Advantage (MA) and Medicare Shared Savings Programs (MSSP). This, however, will need to change as the Medicare Access and CHIP Reauthorization Act (MACRA) and its Quality Payment Programs (QPPs) roll out. Both quality and cost performance metrics used in MACRA QPPs are to be risk adjusted using the same methodology currently used for MA and the MSSP. Consequently, the MACRA QPPs will affect a much larger number of providers than either MA or MSSP.

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