Several industry trends are putting pressure on risk adjustment – including risk-based model enrollment growth, increasingly complex data submission requirements, scrutiny from regulators, and downward reimbursement pressures – signaling the waning utility of traditional approaches.
Health Fidelity defines 360-Degree Risk Adjustment as "the comprehensive set of ongoing activities which project, detect, and capture all commensurate member risk, and thereby risk-adjusted payments, to cover healthcare expenditures for a member population."
It's a fundamentally new way to perform risk adjustment that considers optimization from all angles, including how to modernize technology, enhance provider collaboration, integrate with multiple departments, and obtain performance control and transparency.
The framework is divided into 8 core components:
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