Risk Score Review for ACO at Risk for MA Members
Our client, a large multi-specialty provider, was at risk through an Accountable Care Organization (ACO) contract with a health plan. Payments to the client were risk adjusted; the risk scores included claims for attributed members that were incurred at our client as well as by other providers under contract with the health plan. Our client was concerned that the risk scores assigned were not accurate.
Cirdan received claims data for all members attributed to our client in its ACO contract, including claims from the non-affiliated providers.
Cirdan analyzed the data and identified significant gaps in their data. Cirdan proposed various updates to their processes to address their internal gaps so future risk score projections could be more accurate.