As routine medical services are cancelled or postponed due to COVID-19, prospective risk scores used to pay Medicare Advantage (MA) health plans in 2021 are trending lower than forecasted. Additionally, risk scores for the Health and Human Services (HHS) model used by the Affordable Care Act (ACA) for commercial plans are also trending lower than prior years, according to health plan data compiled by PopHealthCare, Cotiviti’s risk adjustment solutions partner. As the pandemic subsides, health plans should see an increase in demand for elective and routine care, but the limited capacity and re-strategizing required to meet that demand may continue to impact risk adjustment scores and revenue-capturing opportunities.
Despite these disruptions, health plans can use proactive telehealth and remote care strategies to help mitigate the potential negative impact of the pandemic on risk adjustment and quality measurement programs.
