Risk adjustment is an important aspect of establishing appropriate capitation rates. When a set of services is carved out for specific management under a sub-capitation, establishing appropriate adjustments for varying levels of underlying risk is more complicated.
Dive into analytical and operational challenges and resolutions as presenters share more about developing a risk adjustment model specific to the carve-out of behavioral health services through a real-life case study. You will further explore a definition of the use case, availability of historical data sets, selection of the modeling approach, learnings from the iterative modeling process, and the potential application of the results.
After attending this session, you will be able to:
• Understand why a behavioral health specific-risk adjustment model has business value
• Understand the unique challenges related to developing risk adjustment on member and cost subsegments
• Understand the impact of trade-offs between model complexity and interpretability in the context of implementation
• Increase awareness of data nuances and requirements unique to this type of project
• Describe analytic techniques that can be investigated for use in projects of similar business objectives