Health-Based Risk Assessment: Risk-Adjusted Payments and Beyond

January 1, 2004

A number of payers across the country, including Medicaid managed care programs, the Medicare+Choice program, some state employee programs, and a few private purchasing cooperatives, have adjusted their payments based on health status. Researchers generally agree that most health-based risk assessment tools, which are used to determine how much a payment should be adjusted, provide comparable levels of predictability, and a variety of tools are in use today. As payers have gained more experience with these tools and the concept of health-based risk assessment, both the concept and tools have become accepted more widely.