During the pandemic, health plans face a reduced ability to risk-adjust their members and close gaps in care.
Risk adjustment is important to health plans as it determines how much they will be paid in the Affordable Care Act market, managed Medicaid and Medicare Advantage plans.
Under the coronavirus pandemic, risk-adjustment calculations have become a cause for concern.
One question is how COVID-19 claims will affect risk calculations. Another is how the disruptions to regular care in 2020 will lower the prospective risk scores used to pay MA plans in 2021. Read more