episource

Understanding risk adjustment data can be challenging, and standard technology solutions are often one-size-fits-all. That’s why we’ve created a solution that combines the technology and expert teams you need to unlock clinically relevant insights specific to your patient population. We start with the full power of our analytics technology, and then apply the deep subject matter expertise of our risk adjustment team to provide a 360º view of your risk adjustment program performance — where it is today, what’s working, and what isn’t.

The law of the jungle known as “survival of the fittest” was a prevalent theme in the health insurance market in the twentieth century. Prior to 1997, some health plans would hand-pick the population’s healthiest members so that they wouldn’t have to assume significant risk. As a result, people with poor health who were likely to incur substantial medical costs had a difficult time getting insurance coverage. Hence, risk adjustment arose as a solution to improve the overall health of the U.S. population. Risk adjustment gives health plans the necessary incentives to enroll beneficiaries with a variety of health problems — from those who are generally healthy to those who have several chronic disorders.