Can You Predict My Star Rating?

At Accordion Health, we help Medicare Advantage (MA) plans improve their Star Ratings. We identify the right measures to focus and provide data-driven platforms that engage members and providers to improve those measures. The MA Star Rating System is arguably one of the…

Difficulty Of Identifying Diabetic Patients As Diabetic

Risk adjustment has become arguably one of the most important yet complex operational program for modern payers. Every year, payers invest millions of dollars on the risk adjustment program, and still some payers lose million dollars…

How to understand risk for value-based care

by Stephanie Kreml

In healthcare, we see risk has two dimensions: medical risk and financial risk. Traditional actuarial models treat these two as the same, and in doing so, many important characteristics leading to actionable…

Trends in ACA Risk Adjustment: The Rich Get Richer?

The U.S. Department of Health and Human Services (HHS) recently published a summary report on Affordable Care Act’s transitional reinsurance (RI) payments and permanent risk adjustment (RA) transfers for the 2015 benefit year [1]. The…

Two Birds with One Stone: Outcome of Medication Adherence

Medication adherence measures are some of the most important measures in Medicare Advantage’s Star Ratings system. Not only are they heavily weighted measures, but they are also lead measures for other clinical outcome measures.