V42 – Best Practices in Health Insurer and Provider Risk Adjustment Programs


June 12, 2017

  • Results-Oriented Solutions


Event Home | Presenter & Moderator | CPD


Presented by

Health Section


This session will present best practices in design and management of risk adjustment programs. Experts will discuss approaches to improve member and provider engagement, and to align incentives among the many internal departments involved. Health insurers in the ACA marketplace, Medicare Advantage, and Medicaid managed care have their revenue adjusted for their relative morbidity risk. Additional reforms such as, MACRA and the CCIIO bundled payment initiatives will bring a similar transformation to provider reimbursement. Providers have historically relied upon a limited patient view, comprised only of the care they provide. This leads to the belief that their patients are sicker and cost more, and that are provided the highest level of quality care. While many plans are able to identify missing diagnoses, engaging with members and providers to fill those gaps have become much harder. Clinical risk adjusted measurement reporting systems can create longitudinal profiles of patients, which can help push risk adjusted revenue down to network provider contracts to compare providers across their peers, through normalized results and evidence based standards and benchmarks.

How the live virtual session works and what it includes

Connect to the Internet to participate in the session as it takes place at the Health Meeting in Hollywood. The virtual broadcast streams the video, audio and PowerPoint slides through your computer during the session. As a virtual participant, you will be allowed to interact and submit your questions for live response during the session.

You will participate in the virtual session via the Internet. A computer with Internet access and sound capabilities is required. No other equipment is necessary. On June 8, 2017 before 2:00 p.m. CT you will be sent detailed instructions via email including the web address for accessing the program. Any handouts that are available will also be sent. You will follow along with both the slide presentation and the audio portion of the broadcast over the Internet.

The registration fee includes:

  • One access code to the live virtual session;
  • One Internet connection;
  • One phone connection (to be used only if experiencing sound issues or if in a conference room with a group); and
  • One set of presentation materials.

Please note that each access code may only be used for one location , even if you register for more than one participant.

Post-Webcast Purchase Opportunity

For those who are interested in SOA virtual sessions but are unable to participate in the live event, access to an archived recording of the virtual session will be available for purchase approximately 10 business days following the event.




Demonstrating the listening, writing and speaking skills required to effectively address diverse technical and nontechnical audiences in both formal and informal settings.

Professional Values

Adhering to standards of professional conduct and practice where all business interactions are based on a foundation of integrity, honesty and impartiality.

External Forces & Industry Knowledge

Identifying and incorporating the implications of economic, social, regulatory, geo-political and business changes into the design and delivery of actuarial solutions.


Initiating, innovating, inspiring, creating or otherwise acting to influence others regardless of level or role toward a common goal.

Relationship Management & Interpersonal Collaboration

Creating mutually beneficial relationships and work processes toward a common goal.

Technical Skills & Analytical Problem Solving

Applying the actuarial knowledge, skills and judgment required to provide value-added services.

Strategic Insight & Integration

Anticipating trends and strategically aligning actuarial practice with broader organizational business goals.

Results-Oriented Solutions

Providing effective problem solving that addresses relevant interests and needs.