The recent rise in Medicare Advantage beneficiaries, coupled with stringent regulatory requirements, has compelled payers to effectively stratify and analyze the risk of their members. The implementation of risk adjustment not only assists health plans in meeting the ACA mandates but also facilitates enterprises in improving care delivery, reducing medical expenses, and simplifying provider payments. Consequently, payers are seeking to capitalize on risk adjustment technology solutions to expedite their risk assessment and reimbursement processes.

In this report, we examine the risk adjustment solution domain by identifying emerging trends, scrutinizing different market offerings, and evaluating available capabilities against market requirements. The report also provides valuable insights for payers looking to leverage risk adjustment technology solutions and gain a competitive edge in the market.

Scope

• Industry: healthcare payers
• Geography: global

Contents

In this report, we examine:

• Drivers and challenges of risk adjustment solutions
• Trends in risk adjustment
• Models of risk adjustment solutions
• Use cases of risk adjustment for both payers and providers
• Solution ecosystem for risk adjustment

Membership(s)

Healthcare Payer and Provider Information Technology

Sourcing and Vendor Management