Insight
AI-Inferred Risk Adjustment in LEAD: A Quiet but Consequential Shift
CMS’ LEAD model signals a shift from HCC-based risk adjustment to AI-inferred scores, reshaping how patient risk is measured and paid.
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How transitional care management creates value across multiple payment models
A patient-centered, physician-driven multispecialty network used data to improve transitional care management (TCM) outcomes and savings.
The organization launched a TCM program almost a decade ago with just three nurse care managers. But as they increased their participation in risk-based payment models, the large physician-driven multispecialty network needed to assess whether additional investment in TCM could better support patients along their care journey and drive improved outcomes under value-based contracts.
Learn how our customer’s transitional care management achieved:
- 5%–20% drop in readmission rate for patients with TCM
- 15% increase in members with TCM retained within the Medicare ACO
- $1.8 million in savings under value-based care models
- 3 million fee-for-service revenue increase due to greater in-network retention