Risk adjustment

Page last updated on: 4/20/26

Risk adjustment helps ensure a patient’s documented diagnoses accurately reflect their full disease burden. Capturing the full scope of a patient’s chronic and acute conditions contributes to appropriate care planning, care coordination and better patient outcomes. 

See our Risk Adjustment Resources Library below for educational guides on improving risk adjustment documentation and coding. 

Patients

Risk adjustment ensures a patient’s full health picture is accurately captured, supporting appropriate disease burden management, effective care management and coordination and better patient outcomes. 

Providers

Risk adjustment:

  • Helps providers better understand and manage patients’ conditions through accurate and complete documentation
  • Supports accurate provider reimbursement
  • Contributes to better performance in our provider incentive programs

We’re working alongside providers to support preventive screenings, promote accurate chronic condition capture and management and improve health outcomes for high-risk patients through our Disease Burden Management (DBM) Program. Find more information on the DBM Program in the Incentives section of prism (login required).