Category: Risk Adjustment

To navigate the transition to value-based care, healthcare organizations need to integrate both prospective and retrospective strategies into their risk-adjustment programs.

The impact of the pandemic and the evolution of value-based care increase the urgency in needing to understand your risk adjustment program performance.

Combine analytics and expertise to find and prioritize interventions that impact financial and clinical outcomes.

Learn everything you need to know about how DCE beneficiary alignment impacts risk adjustment.

As a thought experiment, let's track a hypothetical EDI file through submission to CMS. As of this writing, there are still two parallel systems involved in the processing of files.

Knowing the hurdles and challenges health plans had to overcome in 2020, we developed a Pandemic Playbook to help navigate the year ahead.

As ACOs face mounting pressure to take on downside risk, we take a deep dive into financial benchmarking to help maximize savings and improve quality of care.

CMS assumes plans have perfect data ready for the RAPS to EDS shift, but what are the real world effects of CMS' 0% Encounter data transition? Episource explores the implications of the 2022 Advance Notice on MA and dual-program enrollees.

On Monday, September 14th, CMS released their annual Advance Notice three months earlier than what has come to be expected. This is a move, that even though it was offered as a possibility, is one more unprecedented occurrence for 2020.

Episource's Director of Risk Adjustment & Payer Solutions, Meleah Bridgeford, reviews CMS' 2021 Rate Announcement and its effects four months into a public health emergency. How has COVID-19 affected EDS Percentages, Coding Trends, and Increased HCCs?

ACOs can use analytics to improve risk adjustment performance overall. Through monitoring of their population, an ACO will know how their current performance compares to their benchmark.

With the recent changes to the existing risk adjustment model and the higher percentage of encounter data that will make up risk scores, health plans are now focused more than ever before on ensuring they’re prepared to secure the same RAF. To assist in your preparations, our Vice President of Client Services gives you the insight on the top priorities you should consider before making important vendor decisions.