Risk Adjustment: This isn’t Dodgeball, People

June 13, 2011
|In Risk Adjustment
|By GHG Advisors

Let’s have a quick check in about risk adjustment and the multi-disciplinary team that should be pushing it to success.

Remember the days of dodgeball?  …picking teams and getting smacked by the red rubber ball?  In risk adjustment, you must ensure your team has the right members, or you’re gonna be left with more than just a ball-shaped bruise on your thigh.  Here are the teams, and some of the members you must ensure are on your committees:

  1. Risk Adjustment Strategy: Risk Adjustment, Finance, Network Management, IT, Compliance and Medical Management, plus an Executive Sponsor
  2. Risk Adjustment and STARS Synergy: Risk Adjustment, Finance, IT, Medical Management, Quality/STARS, Network Management, and Member Services
  3. Risk Adjustment & EDPS: Risk Adjustment, IT, Claims, and Vendor (if you have one selected)

Make certain your team members:

  • Understand the basic rules of risk adjustment
  • Clearly recognize the importance of risk adjustment success

And don’t forget:

  • You MUST have an executive sponsor for those inevitable bumps in the road
  • There MUST be alignment between the departments on priorities and strategies so that there is a clear path to your objectives.

This isn’t dodgeball.  Risk Adjustment is more like Capture the Flag.  There will be winners; there will be losers.  NO TROPHIES for participation.  Pick your team well and keep them focused.