How to perform accurate risk adjustment and manage care
The Centers for Medicare & Medicaid Services' (CMS) defines risk adjustment as "a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs." These days, most healthcare organizations assess risk through retrospection i.e., by analyzing historic clinical records and healthcare data to understand patients' relative health. However, in order to better understand patient health and manage care appropriately, we need more than a view of the past. Accurate and efficient capture of a member's risk requires a forward-looking, prospective view of patient conditions and treatments.
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