Master the complexities of Medicaid risk adjustment with three analytics-driven strategies.
Medicaid risk adjustment relies solely on prospective and concurrent care, requiring plans to have a deep knowledge of their member population. However, segmenting member data by highest priority for interventions can be a challenge.
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The transition from RAPS to the EDS for calculating Medicare Advantage risk scores, payer organizations should have a plan to minimize system errors.
Final Medicare Shared Savings Program (MSSP) rule, called “Pathways for Success,” for Accountable Care Organizations (ACOs).
One of the primary challenges ACOs face with risk adjustment is patient targeting.