Category: Policy

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 […]

3 Reasons to Care About Commercial Risk Adjustment

Anita Joseph

Participating in the commercial insurance exchanges isn’t easy. Plans have to develop a strategy for selling to individuals, set premiums, explain their network offerings to an entirely new consumer set, and orchestrate care for an unexpectedly sick population. Plus, they do all this in the face of intense public pressure and scrutiny. It’s no wonder […]

All About MACRA: Four Takeaways from CMS Chief Andy Slavitt’s Speech to the American Medical Association

Anita Joseph

On Monday, Centers for Medicare and Medicaid Services (CMS) Administrator Andy Slavitt addressed the American Medical Association’s 2016 annual meeting. Slavitt usually leverages such opportunities to send highly specific messages— at the JP Morgan Conference earlier this year, he told an audience of healthcare technology executives that interoperability had to be part of their mandate— […]

Building Physician Engagement Around CMS Risk Adjustment and Clinical Documentation

Anita Joseph

At RISE Nashville this week, we heard over and over that engaging physicians around clinical documentation is a struggle. These feelings echo what statistics have been saying for a long time: in a 2013 survey by the RAND Corporation, physicians described “time-consuming data entry” as a major source of professional dissatisfaction.  Strong CMS risk adjustment is […]