Upon completion of this unit, learners: Demonstrate in-depth understanding of CMS, HHS, and CDPS risk adjustment frameworks. Apply knowledge of model mechanics to assess equitable payment distribution. Analyze diagnosis coding and demographic data for accurate risk score interpretation. Evaluate how model selection influences payment integrity, provider behavior, and health equity. Interpret and communicate findings from risk-adjusted data to support organizational strategy. Recommend appropriate models for specific healthcare programs and population types. Integrate data-driven and policy-based perspectives to inform reimbursement model selection.

Completion of Unit Course on: Fundamentals of Risk Adjustment is required. Learners should already understand the foundational principles of risk adjustment, the purpose of risk scoring, and how these principles support value-based care payment systems.

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This unit benefits reimbursement analysts, financial planners, population health strategists, and policy professionals who engage in the design, evaluation, or management of payment systems. It is also valuable for Medicare Advantage managers, Medicaid program officers, and ACA marketplace administrators seeking a deeper understanding of model-specific risk scoring methodologies.