Risk Adjustment Techniques for Improving Value-Based Payments

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Risk Adjustment Techniques for Improving Value-Based Payments 
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In order for value-based payment models to be sustainable, they need to be designed in a way that is fair to all parties involved. Providers participating in value-based payment models such as capitation or shared savings take on a substantial portion of health insurance risk for the patients that are attributed to them through these programs. Furthermore, employers and insurers with a stake in these arrangements ought to have a keen interest in creating a viable payment mechanism that creates continuity of high-value services for members and meets long-term strategic goals. Care should be taken in the development of value-based payment models to ensure an appropriate balance of upside and downside risk for providers.

A well-constructed provider risk-sharing program ties reimbursement to risks that providers can meaningfully influence, while limiting provider exposure to risks over which they have no control. Risk adjustment is often proposed as a mechanism for limiting the payment risk associated with variation in underlying patient morbidity. Risk adjusters are tools that use member demographics, healthcare claims, or other data to identify underlying morbidity risk factors, so that those factors can be isolated and adjusted for.

While risk adjusters have long been described as a mechanism that improves the accuracy of physician payment, quantifying the expected improvement is essential for value-based stakeholders. This session explores and quantifies the extent to which risk adjustment can reduce the inappropriate variation in reimbursement that is due to underlying patient morbidity, and the residual risks of inaccurate payment that remain after the application of risk adjustment. Quantifying the residual risks can invite the opportunity for further refinement of the payment contract to minimize remaining risks.

Please join us Wednesday, June 8th, 2016 at 2 PM Eastern as Millimanís Colleen Norris and Stoddard Davenport address applying risk adjustment to value based payment models in the HealthcareWebSummit event: Risk Adjustment Techniques for Improving Value-Based Payments.
Learning Objectives

After attending this webinar, attendees will be able to:

  1. Evaluate how value-based payment models come in a variety of forms across the entire continuum of financial risk.
  2. Explore and quantify the extent to which risk adjustment can reduce the inappropriate variation in reimbursement that is due to underlying patient morbidity.
  3. Understand the process for improvement in accurate payment that can be achieved for midsize panels through the application of risk adjustment.
  4. Examine the potential degrees that risk adjustment to improve the accuracy of provider reimbursement.
  5. Consider the definition of accurate payment as one that minimizes physiciansí financial exposure to risks they cannot meaningfully influence.
  6. Ascertain how risk score is a reasonable indicator of a patientís underlying health and the volume of medically necessary services that will be required.
  7. Comprehend how risk score is indicative of the risk that would be beyond a providerís ability to influence care.
  8. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Healthcare Payment and Delivery Transformation and Reform Executives
  • Provider Relations and Contracting Executives and Staff
  • Provider Network Operations Executives and Staff
  • Actuarial Executives and Staff
  • Analytics Staff
  • Finance Executives and Staff
  • Managed Care Executives and Staff
  • Planning and Strategic Executives and Staff
  • Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Health Plans
  • Accountable Care Organizations
  • Provider Networks
  • Hospitals and Health Systems
  • Other Healthcare Providers
  • Employers
  • Third-Party Administrators
  • Government
  • Pharmaceutical Organizations
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
Risk Adjustment Techniques for Improving Value-Based Payments
  Individual Registration Fee: $195. Post-event materials, with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
Register Now   Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!
Colleen Norris

Colleen Norris,
Associate Actuary

  Colleen is an associate actuary with the Denver office of Milliman. She joined the firm in 2008. Since joining Milliman, Colleen has been involved in a variety of projects involving commercial products. Her recent work has focused on assisting healthcare market participants who are taking on risk for the first time in the era of healthcare reform. She has been actively involved in assisting several healthcare CO-OPs with their applications for funding and start-up operations.

Recent projects have involved pricing and reserving of health insurance projects, benefit design and premium development, redesigning rate review processes, and studying the impact of essential health benefits.

Colleen is an Associate in the Society of Actuaries and a Member in the American Academy of Actuaries. She recieved her BS (summa cum laude) in Physics from Creighton University, and a MS in Physics, at the University of California, San Diego (UCSD).

Stoddard Davenport

Stoddard Davenport
Actuarial Assistant


Stoddard Davenport has been an Actuarial Assistant with Milliman since 2011. His specialties including helping behavioral healthcare payors and provider organizations understand and manage their financial risks.

His past projects have included: Behavioral healthcare cost projections; Pricing and reserving; Capitation rate setting and negotiation support; Payment reform modeling; Innovation grant financial modeling; Care management program evaluations; Burden; of; illness studies; Patient attribution; Integration opportunity analyses; Cost and utilization benchmarking; Mental health parity compliance reviews; and Predictive modeling.

Stoddard previously served as an Actuarial Intern with Milliman and received his degree from Boise State University.

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