Availity Blog

Optimizing Risk Adjustment by Going Digital in Providers Workflows


9.06.2016 by AVAILITY


Availity Access provides a glimpse into the people behind our products. It features commentary on challenges facing the healthcare industry and how Availity can help providers and health plans better share healthcare information. In this episode we discuss how health plans can optimize their risk adjustment processes by going digital in their providers’ existing workflows.

To say risk adjustment is complicated would be an understatement. Health plans face many diverse challenges, but there are ways they can adapt. We’ll discuss a few optimization strategies in this episode with Susan Bellile, Availity’s Principal of Health Plan Risk & Quality.

As a refresher, risk adjustment is used to calculate the underlying health status of a health plan’s population. For Medicare Advantage, it is the most significant factor in determining a health plan’s reimbursement. Meanwhile, for exchange plans established under the Affordable Care Act (ACA), risk adjustment determines whether a plan will receive additional funds or be asked to pay additional money at the end of the year.

Today, risk adjustment is also an important component of value-based care models in which health plans and providers are compensated for the quality of care they deliver, rather than individual services.

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