Persivia

Government services such as Medicare and Medicaid are using Risk Adjustment Solutions to alter the funds paid to a healthcare plan based on the health of individuals covered. An actuarial tool calculates how much it is expected to cost to treat and provide insurance coverage to patients in a Risk Adjustment (RA) model based on their present and prior medical histories, demographics, and some other health related characteristics. After determining a patient's risk, he or she is allocated a risk adjustment factor (RAF), or a rating that indicates the person's intrinsic risk of incurring greater medical expenditures. Patients who are healthier and relatively young have a lower RAF, whereas those who have chronic health disorders and are elderly may have a greater RAF. It is obvious that calculating a patient's RAF is important to the efficacy and precision of these models. What criteria are used to designate RAFs? Health issues and disorders are classified according t...