Jay Anders is a physician executive.
As a physician who grew up in a small town in central Illinois, I’ve witnessed firsthand the decline of rural health care in America. The hospital where I first became interested in medicine is now half its original size, merged with a larger health system, and struggling to stay afloat. This story is all too common across rural America, where health care access is becoming increasingly scarce, and the challenges …
Risk adjustment is a statistical method used by health plans to predict an individual’s use of health care services and the associated cost of care. Unlike traditional fee-for-service Medicare, Medicare Advantage (MA) plans receive a flat monthly payment for the individual beneficiary’s cost of care, with payments partially based on risk score.
Higher risk scores mean higher payments, and plans have financial incentives linked to more thorough documentation (coding) of their …
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