A member of the American Medical Group Association as well as the American Association for Physician Leadership, Pachavit Kasemsap, MD, worked as a medical director at WellMed Medical Group. While at WellMed, Dr. Pachavit Kasemsap raised the market RAF score and enhanced the combined HEDIS quality metrics.
Also known as RAF, risk adjustment factor is a measure of the probable costs needed to meet the healthcare requirements of an individual beneficiary. A beneficiary’s risk adjustment factor is determined by assessing the individual’s health condition, particularly those conditions that fall within a hierarchical category as well as demographic factors that encompass gender, age, and other parameters including residence and attended institutions. In general, older individuals usually have a higher RAF compared to younger individuals. Individuals with a history of certain medical conditions may also have a high RAF compared to individuals that do not have such history.
The role of RAF is to guide the adjustment of capitated payments for beneficiaries that are enrolled in Medicare Advantage plans as well as some certain demonstration projects. Usually, the payment depends on the report of patient data, which will be provided by a qualified healthcare service provider and further used in estimating the expected cost to maintain the patient’s health. As a result of this, the reports must be complete and accurate since incorrect or non-specific diagnoses in the report can affect the patient’s health care reimbursement.
Pachavit Kasemsap 