The Importance of Risk Adjustment in Value-Based Care Contracts

Tuesday, August 15, 1-2 p.m. EST



Jason Jobes, BA, MSPA, SVP Solutions, Norwood


Register here: 


It’s no secret—healthcare reimbursement is evolving before our eyes, from traditional fee-for-service to value-based care/pay for performance. Medicare Advantage is poised to surpass traditional Medicare this year in the number of covered lives.


Good documentation remains as important as ever in this new environment, but there are several critical differences when working within a risk-based contract that includes capitated payment. Formerly adversarial payer relationships become partnerships, and patient scheduling becomes paramount in order to capture HCCs that reflect patient complexity. All of which is under heavy scrutiny from the likes of the Office of Inspector General.


Join Norwood SVP Solutions Jason Jobes on Tuesday, August 15th for this free 60-minute webinar. We’ll cover:


  • Payer relationships, and how CDI and coding leaders and their respective organizations should approach payers with whom they have had (and likely still have) an adversarial relationship, but now find themselves in a shared savings agreement that rewards cooperation.


  • The importance of patient scheduling, including leveraging your case managers, social workers, and population health team to get patients in to be seen. Both to manage their health in less expensive settings but also to capture risk. Annual Wellness Visits can play a large role here.


  • What if you don’t have an OP CDI program? How to figure out where your opportunities lie and where to start. Hint: It’s about understanding and seeing your patients, knowing what risk program they are in and what clinical conditions they have, and seeing them at least annually. And monitoring process and outcome metrics to ensure that patient complexity is fully captured.


  • The Medicare Advantage 2024 Advance Notice final rule and the anticipated impact of the transition from V24 to V28 of CMS-HCCs over three years (2024-2026).


  • The current landscape of intense regulatory scrutiny, and the corresponding shift from revenue maximization/capture to compliance and revenue protection. We discuss Jason’s recent series on LinkedIn analyzing the seemingly endless stream of OIG audits of Medicare Advantage payers on presumed overcoding, including ongoing patterns of (likely) error.


If you missed this super well-received session at the 2023 ACDIS Symposium/Outpatient CDI now’s your chance to hear it again.


Register here: 


Learning objectives

  • Learn the risk and value-based landscape, including tactics to succeed in risk adjustment
  • Accurately depict patient populations to help control cost of care and ensure patient complexity
  • Reduce compliance risks and achieve success in value-based contracts


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