Category: Policy

What America Can Learn from the U.K.’s Experience with Risk Adjustment and Population Health

Andrew Raymore

  We’ve discussed on the Apixio blog how critical risk adjustment is to the functioning of a healthy insurance market in the U.S., but how is risk adjustment applied in the healthcare systems of other countries? What makes this a fascinating question is that many other countries provide health insurance for a greater percentage of […]

4 Things Risk Adjustment Leaders Need To Know About the 2018 CMS Final Call Letter

Anita Joseph

Recently, the Centers for Medicare & Medicaid Services (CMS) released its Final Medicare Advantage (MA) Part C and D Call Notice for 2018. We combed through the  notice, and here is what we think risk adjustment professionals need to know.   1. What is the final call notice and why is it important to risk […]

2017 RISE Nashville Recap: Transforming Healthcare Through Data

Anita Joseph

At the 2017 RISE Nashville conference Apixio hosted a panel with four of our clients: Doug Loop of OptumCare, Russ Shust of Group Health Cooperative, Jennifer Pereur of Hill Physicians Medical Group, and Alicia Wilbur of Martin’s Point Health Care. The panel was moderated by Tam Pham,a risk adjustment expert, currently on board with Apixio […]

Healthcare Reform Lessons from Medicare Advantage

Mark Scott

With replacement or adjustment for the Affordable Care Act (ACA) back on the administration’s agenda, Medicare Advantage continues to emerge as a bright spot of bipartisan agreement; earlier this year, 65 Senators signed a letter in support of the program. So what makes Medicare Advantage the poster child for healthcare reform? In a nutshell: It […]

ACA Repeal and Replace Collapses. What Does It Mean for Risk Adjustment?

Andrew Raymore

On the last day of RISE Tennessee, the risk adjustment industry’s largest conference, the Republican-controlled House unveiled their Affordable Care Act (ACA) replacement plan. Debate over the American Health Care Act (AHCA) was fierce, with many key organizations such as the American Association of Retired Persons, and the American Medical Association coming out in strong […]

The RISE Nashville 2017 Keynote Address: “Politics: From the Top and the Inside and Its Impact on the Healthcare Landscape”

Andrew Raymore

One of the most anticipated presentations at the 2017 RISE Nashville conference was the keynote address by Howard Fineman, Global Editorial Director of The Huffington Post and an analyst for NBC News and MSNBC. A somewhat politically charged speech, it was as frank and hard-hitting as Mr Fineman is known to be. Below are our […]

Why is Risk Adjustment Important to the Affordable Care Act?

Andrew Raymore

You may have heard what happened at a recent town hall meeting about the Affordable Care Act (ACA) in Tennessee. A woman stood up and said, “As a Christian, my whole philosophy in life is to pull up the unfortunate” adding “So the individual mandate, that’s what it does: The healthy people pull up the […]

Top 5 Questions Facing Risk Adjustment in 2017

Anita Joseph

From the looks of it, 2017 will be a big year for risk adjustment. There is a new administration in power in Washington, which will have far-reaching implications for the entire healthcare industry. And the risk adjustment space specifically will have to look inward, as it manages the currents of technological change and pries itself away […]

Conquering Commercial Risk Adjustment

Anita Joseph

Risk Adjustment an Important Business Factor for Commercial Exchange Plans In theory, the commercial risk adjustment program was intended to help insurers taking on the heaviest load from the commercial health exchanges. Health insurers would submit risk scores for each enrolled patient to HHS. HHS would calculate an average risk score for each plan and then mandate cash […]