Risk Adjustment & Finding Value Beyond Coding Changes
“If risk adjustment is just about ‘getting every possible code’ you miss the point. The real differentiator is embedding value into your client’s care journey.”
Risk Adjustment & Finding Value Beyond Coding Changes
I recently joined The Agent Survival Guide Podcast to dig into one of the most misunderstood—and under-leveraged—areas in health insurance: risk adjustment.
🔍 Why this matters
In our conversation, I made a point that coding (V24 → V28 changes) is just one piece of the puzzle. The real value lies in how agents and brokers can:
— Think holistically about quality, care, and process design — not just maximizing codes
— Align incentives so that member health outcomes and financial sustainability both improve
— Use risk stratification and data as tools for client advocacy, not just cost control
One thing I emphasized:
“If risk adjustment is just about ‘getting every possible code’ you miss the point. The real differentiator is embedding value into your client’s care journey.”
We also unpacked the biggest challenges agents face in navigating coding updates and regulatory noise, and how to stay proactive rather than reactive.
This episode is ideal for:
— Agents & brokers seeking to differentiate themselves in a crowded market
— Payors or partners exploring how to unlock higher value beyond compliance
— Anyone curious about how value-based care, coding, and outcomes intersect