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By Pulse8 Payers stratify premiums for a given benefits package by the member s relationship to the policy holder, and if permitted, by age or gender. This stratification discourages enrolling higher-risk, hence unprofitable, members. Risk-adjustment (RA) aligns premiums with the cost of caring for members with documented conditions, removing that incentive and encouraging the enrollment of higher risk members.¹ The magnitude of these adjustments can be thousands of dollars per member each year and can easily exceed the typical profit margin of plans.¹ Therefore, complete, accurate and ongoing sizing of these opportunities drive the payer s strategy.² ³ Gaps are closed by confirming each member s open  conditions from claims or reviews of medical records, which can be expensive. However, confirmations supply needed revenues for their care, and sophisticated risk-adjustment analytics can identify undiagnosed conditions for earlier, more effective care.² ³ Let s examine

United statesNational health councilRisk adjustmentDynamic interventionIntervention planningNational healthUpdated januaryHealth care costs through patient targetingRisk adjustment modelingPredict patients remaining highRisk adjustment analyticsFinancial reportingAccessed marchTwo pronged approachஒன்றுபட்டது மாநிலங்களில்தேசிய ஆரோக்கியம் சபை