NEMG did not have accurate reading of their risk score represented in this patient population. This prevented them from being able to estimate the level of risk they could take on for both their Medicare Advantage and ACO populations. An ACO’s risk score is directly related to reimbursement rates from CMS.
NEMG needed to determine a realistic projection of the clinical and financial risk carried by their Medicare patients, which ultimately would allow them to better provide high-value, patient-centered care.
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