Worcester-based Fallon Health and two other insurance plans have asked the state’s Health Connector Insurance Authority to review risk assessment fees that they say could financially impact smaller ...

The Centers for Medicare and Medicaid Services has reestablished the risk adjustment payments it froze earlier this month due to a court case over the program and, as such, will be paying out $10.4 ...

On December 31, 2019, a three-judge panel of the Tenth Circuit Court of Appeals upheld the methodology adopted by the Department of Health and Human Services (HHS) to administer the risk adjustment ...

Value-based payment programs adjust payments to providers based on spending, quality, or health outcomes. Concern that these programs penalize providers disproportionately serving vulnerable patients ...

Commercial health plan initiation of a co-pay accumulator adjustment program for specialty medications treating autoimmune diseases was associated with significant reductions in medication adherence ...

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying ...

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models.

Leavitt Partners: What major insurers have to say about CMS’ risk adjustment program The Patient Protection and Affordable Care Act (ACA) introduced restrictions on underwriting and new federal ...

In a new final rule, CMS reissued the Affordable Care Act's risk adjustment program for payers in the ACA exchanges for the 2018 benefit year. The reissue includes an additional explanation of the ...

In early July, the Trump administration announced that it would suspend $10 billion in transfer payments to insurers after a federal court ruled that Obamacare's "risk-adjustment" program was flawed.