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Advance Possibility

Why Physicians In Value-Based Contracts Need To Get Ahead Of Risk Adjustment

Physician stethoscope
Meleah Bridgeford
Sr. Director of Risk Adjustment Analytics
February 15, 2023

This article was originally published in Medical Economics on February 13, 2023 here.

With the Centers for Medicare & Medicaid Services (CMS) pushing to tie 100% of reimbursements to value-based contracts by 2025, many physician practices are in the process of preparing to take on additional financial risk. Though there are still two years before we reach this deadline, there are many moving parts involved in making the shift from a fee-for-service (FFS) model to a value-based model. From analysis to buy-in, negotiations, and internal and external education, making the transition is no easy task.

To help practices prepare for this transition, we have laid out our top three considerations for success:

Know your population’s risk score.

To properly account for the risk of your patient population – that is, how healthy or sick they are – your risk adjustment and coding data must be complete and accurate. Gaining insight into your patient population will allow you to stratify your high-need, high-risk members (e.g., those with diabetes) into cohorts and determine the best interventions and strategies to manage their care. This will help ensure you receive the proper reimbursements. It will also allow you to be clear-eyed about any contract you enter into where you have to own more financial risk than a traditional FFS model.

To read more, visit our article in Medical Economics here.