Many issuers in the ACA don’t have a comprehensive risk adjustment strategy—leading to lost opportunities and less-certain financial outcomes. In this series, we provide guidance on creating a risk adjustment program to address these gaps.

In recent years, CMS has implemented a variety of episode-based payment models. This paper provides a high-level guide to the unique and complex risk arrangements for providers under four of these models.

Quickly learn the fundamentals of risk scoring for Medicare Advantage plans, including the impact of diagnosis submission on payment timing.

Understand the benefits of shifting from location-based to functional risk adjustment in Medicaid Managed Long Term Services and Supports (MLTSS) programs.

When confronted with rising costs and shrinking reimbursement, leaders at a hospital in California took a bold step to ensure that they could continue serving the needs of the community in a financially sustainable way.