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For years, ACA Risk Adjustment was treated as a technical requirement—important, but largely operational and retrospective in nature. That framing no longer holds.
In today’s environment of margin compression, RADV pressure and performance volatility, Risk Adjustment has become one of the few controllable levers plans still have.
Accuracy is no longer optional. It directly affects revenue integrity, forecasting confidence and enterprise decision-making.
When Risk Adjustment is managed as a siloed, back-office function, plans expose themselves to preventable financial risk and downstream disruption.
Leading organizations are reframing Risk Adjustment as an enterprise capability. They connect data, clinical documentation, analytics, finance and operations into a coordinated model—one that supports both accuracy and sustainability.
This Shift Changes the Conversation:
- From retrospective reconciliation to proactive margin protection
- From isolated technical work to cross-functional accountability
- From “getting it done” to getting it right
In 2026, Risk Adjustment performance is not just a technical success factor. It is a strategic one.
