Tag Archives: Michelle Klein

The “Rxisk” of adjustments in 2018 ACA risk adjustment

The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model. Starting in 2018, a condition will be identified through a Hierarchical Condition Category with associated medical diagnosis codes, a prescribed medication, or both—each one affecting the final risk member score differently. This paper by Milliman consultants approximates the likely CMS mapping based on the publicly available information to date.

Pent-up uncertainty may lead to more demand among Americans

While legislation to repeal and replace the Patient Protection and Affordable Care Act (ACA) has halted for now, the future of American healthcare remains in flux. In this article, Milliman’s Kim Hiemenz and Michelle Klein discuss how the uncertainty surrounding healthcare may lead to pent-up demand among many Americans.