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“Risk adjustment is central to creating fair bundled primary care payments, because the costs and complexities of caring for patients vary enormously.”

 

~Dr. Arlene Ash, PhD

Risk Stratification

Risk stratification attempts to quantify the level of complexity of each patient and allocate resources accordingly. Primary Care clinicians and practices caring for more complicated patients would get paid more than those with less complicated patients.


Dr. Arlene Ash at UMass developed the Neighborhood Stress Score (NSS) to more reliably predict a patient’s social complexity by using their street address. It is essential to account for both medical and social risk.The NSS has been used successfully by MassHealth for many years. The PC4You legislation aims to replicate the model being used by MassHealth. This will maximize health equity by allocating resources where they are needed the most.

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