Risk Adjustment:
An Integrated System for Value-Based Care

Shifting into a value-based reimbursement environment is a transformational endeavor. VBC turns the traditional model on it’s head by focusing on the patient, not the encounter. Taking the approach to keep patients healthy versus treating them when they are ill causes providers to approach their care in much different ways. Achieving the right outcomes with risk adjustment requires healthcare organizations to trade silos for an integrated approach. 

Change is never easy or a straightforward path. It’s difficult for many organizations to get started when they think about all of the factors that have to be considered. Others have gotten started in their transformation but have not experienced the outcomes they are seeking. Risk-adjustment needs to be addressed head on. Success is rare if trying to “fit” care for risk adjusted patients into using current mindsets, people, processes and tools. While this can be overwhelming at first, it’s important to think big picture, but act purposefully.  In our experience, we have found using a system framework helps make the process manageable and helps providers see how to be successful. 

Our system framework is comprised of 5 key components (or elements) that need to be in place to think and plan the transformational effort. The relationship between each component requires consistent monitoring and evaluation for continuous improvement to ensure a viable, beneficial system. 

Strategize, Measure, Align, Resource, and Transform
for a Future-Ready Healthcare System