Blueprint for VBC: Building compliant, sustainable risk adjustment programs

With regulators tightening oversight of risk adjustment and coding, Jason Jobes, senior vice president of Solutions at Norwood, says organizations must pursue what he calls “revenue maximization and revenue protection.”

“Revenue maximization does nothing if you ultimately lose all of that because of a fraud, waste, and abuse lawsuit,” Jobes says. “You’ve got to audit. That means auditing coders, auditing clinicians. You’ve got to benchmark yourself.”

Drawing from more than a decade of experience in Medicare Advantage, Jobes notes that compliance must now be embedded in every level of financial strategy. “Organizations need to know their data and involve compliance,” he says. “Really strengthen the clinical documentation integrity piece — it’s not just coding. It’s about teaching clinicians how to document as effectively as they can.”

He emphasizes that sustainable success in value-based care (VBC) depends on a closed-loop system of education, auditing, and collaboration. “It’s all about feedback loops,” he says.