Risk Adjustment
Expert articles and analysis related to risk adjustment.
AI Summary — Last 30 Days
ACO strategy is shifting from model selection to risk engineering as LEAD acceptance letters go out, Participant TIN lists come due to CMS in early August, and organizations that applied to both LEAD and MSSP must choose a pathway before final methodologies are released later this summer; that creates near-term pressure to model attribution, benchmark exposure, stop-loss needs, and provider participation under still-evolving CMMI rules (Wakely on LEAD risk mitigation). At the same time, Medicare Advantage risk adjustment remains under scrutiny as CMS continues to target coding intensity and payment accuracy, raising the strategic stakes for documentation, encounter-data integrity, and defensible coding across MA, MSSP, and CMMI models (KFF on MA coding intensity). For VBC stakeholders, the common thread is that risk adjustment is no longer just actuarial plumbing—it is becoming a board-level operating capability linking contract choice, data infrastructure, compliance posture, and downside-risk protection.
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Predictably Unpredictable: Medicare Risk Adjustment
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