Risk Adjustment

Beyond the Data Weeds: Analytics for Stronger Performance Across the Risk Adjustment Lifecycle

Written By
Vijaya Vishwanathan
Director of Product, Episource

Do you have a clear picture of your data, and tools that allow you to easily identify the most impactful interventions to improve patient care?

We recently asked this question during our presentation at the 7th Annual RISE Medicaid Managed Care Leadership Summit, and an overwhelming majority of participants—more than 75 percent—answered “sort of” or “not at all.”

With the sheer volume of health care data available today, it’s no surprise that many health plans find themselves in the data weeds, lacking visibility into provider performance and clarity around which members most urgently need care. While risk adjustment is a complex process for all plan types, Medicaid is especially challenging. For one, each state has its own rules, exclusions, coefficients, and calculations, making it difficult to project revenue and schedule targeted care programs. What’s more, Medicaid member data is also very transient and the Medicaid population is rapidly growing—increasing by 15.7 million members during the pandemic alone.

To read the full article, visit RISE.


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider