2024 SOA ImpACT Conference - Session 7D: Correlation Observations: Risk Adjustment and Cost of Care 10.29.24 Recording

A priori, one would expect In Home Assessments (IHA) and Telehealth (TH) Encounters to identify some conditions that lead to actions that keep a member or two out of the Emergency Room. Similarly, one would expect Care Management and Disease Management engagement to ultimately influence some improvement in documentation that leads to more accurate Risk Adjustment. The business cases for these activities are often siloed to only the primary activity. The relationship between risk adjustment and care management is often more recognized as competing interests - one generally relying on utilization and the other trying to reduce it. Business cases can change dramatically when profiling has a more complete picture. This session will explore some techniques and share some observations - positive and negative - of the interactions between CoC and Risk Adjustment.