How Strong Risk Adjustment Protects Long-Term Financial Stability?
Healthcare organizations in value-based contracts get paid based on patient outcomes. But not all patients cost the same to treat. A practice with mostly healthy patients spends less on care. A practice treating patients with diabetes, heart disease, and kidney failure spends far more. Risk Adjustment fixes this imbalance by paying providers more when they manage sicker populations. Organizations treating the most complex patients get higher payments. Without it, providers go broke or turn away patients who need care most. What is Risk Adjustment? Risk Adjustment changes how much providers get paid based on how sick their patients are. Insurance companies and Medicare use diagnosis codes from patient charts to figure out who costs more to treat. Someone with heart failure, diabetes, and lung disease needs frequent appointments, medications, and monitoring. Someone healthy needs an annual checkup. Risk adjustment pays providers different amounts for these two patients. Medicare A...
