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Changes to risk adjustment are coming. Are you prepared?

August 2023 | 3-minute read

Alexandra Povlishock is a senior health care leader with over a decade of experience optimizing health care technology in large, complex health systems. She joined Optum as vice president of Clinical Solutions in 2018. Previously, she was a vice president at Advisory Board and served in a leadership role at a leading health care consulting firm in Washington, D.C. Alexandra holds a master’s in health administration from Virginia Commonwealth University and a bachelor’s degree in cognitive science and biology from the University of Virginia.

The Centers for Medicare & Medicaid Services released its much-anticipated Contract Year 2024 Medicare Advantage and Part D Final Rule in April. And while it may not make for light bedtime reading, the new policies will impact patients, payers and providers. Let’s take a look at how your practice will need to evolve to proactively anticipate the upcoming changes.

A patient-first approach

Like you, I spend a great deal of time thinking about risk adjustment. I focus on supporting payers and providers in improving their risk adjustment accuracy by shifting the focus to the point of care and improving health outcomes. This approach allows for a more accurate assessment and diagnosis of patient acuity and risks. 

In its purest form, risk adjustment is about having an accurate, complete picture of each patient’s health status and needs so that patients receive high-quality clinical care. Unfortunately, risk adjustment has also become an administratively fraught process. The process can burden practices with tasks that take precious time away from what they were trained to do: focus on patients and their health concerns.

New rules, risk adjustment accuracy and you

When I read through the 2024 changes, I focused on sections related to the clinical and administrative elements of medical practice. At a basic level, the rule impacts the number and type of conditions that risk adjust and the relative financial value of risk adjustment overall. 

If your practice takes on risk in some form — whether downside risk, shared savings or some other value-based care arrangement — now is an excellent time to step back and assess your performance and understand how upcoming changes will have an impact.

To start, evaluate your patient activation and engagement strategies. These approaches will make an outsized contribution to your success. Consider the following questions:

  • Does your practice have a complete, accurate picture of its patient population?
  • Are you using appropriate external data sources to inform what you know about your patient population?
  • Are you effectively collaborating with payer-based programs that support bidirectional sharing of patient insights and risks?
  • Do you have a comprehensive process to assess patients annually for ongoing wellness and chronic disease management?
  • Are you in a position to take on more risk?

It takes a village

For most physicians, the challenge isn’t a lack of data. Instead, it’s finding ways to use data effectively and efficiently. Over my career I’ve worked in clinical settings, as an administrator, as a consultant and now with a health services technology company. I’ve seen firsthand that working with a third party can add immediate value and scale for risk adjustment programs to improve patient care. These collaborations can provide customized services to help your practice access and use data meaningfully in the patient care setting. Look for a vendor that offers:

  • A thorough assessment of your practice’s needs, capabilities, resources and goals
  • Streamlined, simplified processes and workflows that mitigate compliance risk and improve performance
  • Capabilities that allow your practice to share data and insights seamlessly with payers
  • Analytics and clinical algorithms to assist with pre-visit planning and follow-up care for each patient

The right relationship will support your priorities and increase your digital footprint. This will allow your practice to focus more on building lasting relationships with patients and less on administrative tasks.

Now is the time to fine-tune your approach

In the weeks and months ahead, health systems and medical practices will learn whether they are well-positioned for 2024 risk adjustment changes. Now is an ideal time to consider your approach and how you collaborate with payers and vendors in order to adopt and comply with these changes.


Webinar: "Using Clinical Insights to Impact Patient Outcomes.” Learn more about how 2024 changes may impact physicians.

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