Risk Adjustment Odyssey
Forthcoming 2026
Richard Lieberman
Forthcoming Book

Risk Adjustment Odyssey

Operational Guidance for Clinicians, Lawyers, Subject Matter Experts, & AI Practitioners

The definitive resource from one of the field's founding practitioners — a comprehensive guide to government-regulated health plans and value-based payments.

Targeting Q4 2026 · Self-Published
What's Inside

Table of Contents

1Setting the Stage for Risk Adjustment
2The Evolution and Development of Health Insurance Coverage
3Stakeholders in the U.S. Healthcare Delivery System
4Finding the Rules of Risk Adjustment
5The Professionals of Risk Adjustment and Rate Setting
6Data and Data Flows of Risk Adjustment
7Employment-Based Insurance and the Role of Risk Adjustment
8Overview of the American Healthcare Financing System
9Value-Based Care
10Statutory Authorities
11The Affordable Care Act
12Modeling and Statistical Inference
13State Medicaid Programs
14The Medicare Program
15Medicare Risk Adjustment and Rate Setting
16Affordable Care Act Marketplaces
17Risk Adjustment for Clinicians
18Providers Vs. Payers in Value-Based Care Initiatives
19Risk Adjustment in Private Value-Based Payment Initiatives
20The Role of Quality Improvement in Risk Adjustment Schemes
21Revenue Optimization in Risk Adjusted Programs
22Oversight in Risk Adjustment
23Risk Adjustment Outside the United States
24Interoperability
25Risk Adjustment Will No Longer Be Needed Because…
26Conclusions and Policy Recommendations
27Sources of Accurate and Unbiased Detailed Information

Peer-Reviewed Publications

2009
Disaster-related injuries in the period of recovery: the effect of prolonged displacement on risk of injury in older adults.
Uscher-Pines L, Vernick JS, Curriero F, Lieberman R, Burke TA. Journal of Trauma. 2009 Oct; 67(4):834–40.
2009
Health of Medicare Advantage Plan Enrollees at 1 Year After Hurricane Katrina.
Burton LC, Skinner EA, Uscher-Pines L, Lieberman R, et al. American Journal of Managed Care. 15:13–22, January 2009.
1998
The development of a risk-adjusted capitation payment system: the Maryland Medicaid model.
Weiner JP, Tucker AM, Collins AM, Fakhraei H, Lieberman R, et al. Journal of Ambulatory Care Management. 1998:21:29–52.
1992
Johns Hopkins Ambulatory Care Groups (ACGs): A Case-Mix System for Utilization Review, Quality Assurance and Capitation Adjustment.
Weiner JP, Starfield BH, Lieberman RN. HMO Practice. 1992;6(1):13–19.
1993
Using SAS to Analyze Health Status in Insurance Claims.
Lieberman R. Paper presented at SESUG '93, 1993.

Selected Conference Presentations

2019
Success in Risk-Bearing Arrangements; More Risk Score! Running a Compliant Medicare Advantage Risk Adjustment Program That is Also Profitable
Society of Actuaries Health Section Meeting · Phoenix, AZ
2017
Reconciling the Ins and Outs of the Encounter Data Stream; Medicaid Quality: A Key Driver of Plan Financial Performance
RISE-West · Hollywood, CA & Society of Actuaries Health Section Meeting · Hollywood, FL
2017
Integrating the Johns Hopkins ACG System with Other Proprietary and Non-Proprietary Tools
Johns Hopkins ACG System Spring Training Conference · San Juan, Puerto Rico
2016
Value-Based Payments: The Health Insurance Core System of the Future, the Role of Data in Support of Analytics
Oracle Industry Connect · Orlando, FL
2015
The Changing Face of Value-Based Payments (Keynote)
AHIP National Institute · Nashville, TN
2015
Key Features of Risk Adjustment Models; Risk Adjustment 2015 – the Legislative and Political Climate
ICE Annual Conference · San Francisco & Risk Adjustment Forum · Ft. Lauderdale
2013
Risk Adjustment and Quality Improvement in the Dual-Eligible Demos (Keynote)
7th Annual RISE Summit · Nashville, TN
2012
Quality Improvement in Managed Care Plans: Can Analytics Drive Performance? (Invited Speaker)
SAS Analytics 2012 Conference · Orlando, FL

Selected Webinars (40+)

Mar 2016
The Advance Notice of Methodological Change: Key Changes
Feb 2016
The Upheaval of Risk Adjustment: Dramatic Impending Changes
Nov 2015
Pharmacy-based Risk Adjustment
Sep 2015
ICD-10 and Risk Adjustment
Aug 2015
Risk Adjustment and Medicaid
Jun 2015
The Value Based Transformation of Medicare
May 2015
Predicting Emergency Room Utilization and Hospital Readmissions
Jan 2015
Impact of Star Ratings and the Quality Rating System on Health Plan Operations
Jun 2014
Risk Score Optimization Across Multiple Lines of Business
Feb 2013
Risk Adjustment in the Exchanges
Dec 2012
Stars Quality Measurement in 2013 and Beyond
Oct 2012
Maximizing Revenue in Risk Adjusted Medicaid Managed Care Plans