MCOL March 4, 2021
Clive Riddle

Sherlock Company’s March issue of Plan Management Navigator tackles the topic of Medicaid risk adjustment expenses and premiums pmpm. Their analysis attempts “to measure the efficacy of risk adjustment expenses on premium rates” for Medicaid plans; because “as a result of the increased population of Medicaid members, there is a growing need to accurately capture risk scores so that compensation to the plan is commensurate with their health care requirements.”

So what exactly is “risk adjustment” in this Medicaid plan context? They explain “the Sherlock Benchmarks define Risk Adjustment as the expenses associated with the analysis of clinical data in order to match government compensation with the risk factors of members. This includes adjustment for the “three Rs”: permanent risk adjustment, transitional...

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