Why physicians in value-based contracts need to get ahead of risk adjustment

To help practices prepare for their value-based care transition, here are three top considerations for success. With the Centers for Medicare & Medicaid Services (CMS) pushing to tie 100% of reimbursements to value-based contracts by 2025, many physician practices are in the process of preparing to take on additional financial risk. Though there are still two years before we reach this deadline, there are many moving parts involved in making the shift from a fee-for-service (FFS) model to a value-based model. From analysis to buy-in, negotiations, and internal and external education, making the transition is no easy task. To properly account for the risk of your patient population – that is, how healthy or sick they are – your risk adjustment and coding data must be complete and accurate. Gaining insight into your patient population will allow you to stratify your high-need, high-risk members (e.g., those with diabetes) into cohorts and determine the best interventions and strategies to manage their care.