Our Company

External Data Gathering Environment server management is technically demanding and resource-intensive, and issuers are still looking for a better, faster, and more efficient solution to ease the burden and streamline the reporting process for risk transfer calculations.

This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.

This paper addresses strategies to facilitate an organizational coding completeness initiative and “crack the code” on the tools and methods for increasing risk adjustment management’s success.

This paper explores some of the more useful types of analytics a commercial health plan can leverage to monitor the performance of its Patient Protection and Affordable Care Act block and keep a better risk score.

The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model, and this paper approximates the likely CMS mapping based on the publicly available information to date.

This paper outlines action steps health plans should consider as part of their annual EDGE server submission cycle.

The initial 2015 risk adjustment report shows the magnitude of the transfer payments continues to significantly affect the financial results of many issuers.

This study explains how risk adjustment might influence profitability patterns in a typical year and whether those patterns change with the size of a health plan.

The nuances and interactions inherent in the 3Rs can generate impacts that turn traditional risk management practices upside down.