Healthcare Finance News September 28, 2022
Susan Morse

Physicians see the need to reduce the gaming of risk adjustment and to create accountability focused on outcomes, not processes. 

Improving health equity requires changes to risk adjustment, physicians said Tuesday.

Current risk adjustment underestimates the total cost of care of patients who have comorbidities and socially complex issues, said physicians who spoke Tuesday during a Primary Care Collaborative session on achieving equitable primary care services. 

Current Hierarchical Condition Category (HCC) coding used for risk adjustment focuses on a single disease without taking into account whole-person care, they said.

Socially complex issues can often lead to higher utilization of healthcare, said Dr. Tracey Henry, an associate professor of Medicine at Emory University and a general internist.

She gave the example...

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