Developing New Risk Adjustment Models for Adjusting Costs and Performance Measures
The Affordable Care Act moved diagnosis-based risk adjustment to center stage, both by embracing risk adjustment for health insurance exchanges and by encouraging payment innovation and improved performance measurement. Almost all envisioned reforms, including Affordable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Pay-for-Performance, and the state health insurance exchanges simply assume the existence of adequate risk adjustment models. The papers in this session (1) study existing risk adjustment models for bundled payments and set forth principles for building new models with limited data; (2) study ways to adjust the timing of risk adjustment to better correspond with the data that will be available in the state health insurance exchanges; and (3) study the diagnostic coding that all modern risk adjustment models are based on. The risk adjustment experts presenting in this session will provide researchers and policymakers with the tools they need to build and implement risk adjustment models in various contexts.