Earlier this month, the Center for Medicare & Medicaid Services announced that they will be calculating 2020 risk scores by adding 50% of the risk score using diagnoses from encounter data (supplemented with diagnoses from RAPS inpatient data) and FFS data and 50% of the risk score calculated (using the 2017 CMS-HCC model) using RAPS and FFS diagnoses. This doubles the current percentage of encounter-based risk scores used for the final calculation, meaning every encounter reported up stream will soon be more important than ever.
My optimistic view… As a provider of health care services, there is always concern with how and who will be paying for the services that are provided to patients in government programs. As a consumer, you are concerned with how you will be able to afford your premiums when they once again increase disproportionally with your income.
But the principles of quality, affordable care have remained consistent in the health care bubble that I have been involved in for over twenty years now -- Keep people well and out of the hospital and health care costs will remain low. From the early days of managed care, provider groups who were proactive in member wellness and management activities grew and flourished. Government agencies and health plans noticed these successes and began incorporating quality measures into incentive programs in a wide variety of forms. Unfortunately, these incentives led to mandates and extensive regulation and administration for everyone in the industry…driving up the administrative costs.