Expanding Health Care Coverage

Project Title

Health Reform: Implementing Risk Adjustment in the New York Context

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

November 29, 2011


Outside New York State






A goal of the Affordable Care Act (ACA) is to create market conditions in which insurers’ prices reflect the underlying value and efficiency of their products, rather than the composition of their risk pools.

Thus, the ACA provides an opportunity for New York to rethink its risk management methodologies and to develop a new proposal to the Federal government. Wakely Consulting Group was funded by the Robert Wood Johnson Foundation (RWJF) to provide technical assistance to New York State in the development of its risk adjustment approach. NYHealth’s support leveraged the RWJF grant and supported a stakeholder engagement process to elicit candid insights from health plans and other stakeholders and lead to practical solutions for New York.

Specific stakeholder engagement activities included:

  • A Policy Expert Roundtable with diverse stakeholders who discussed the risk adjustment requirements of the ACA, current mechanisms in use in New York State, and the options available to New York. Wakely provided an update of new Federal regulations and participants had the opportunity to provide their input on the final product to be produced by Wakely for New York State.
  • A daylong meeting with health plan technical experts to explore key issues for the design and implementation of the ACA’s risk adjustment system in New York. The group will also discuss the lessons they have learned from administering the various risk adjustment methods currently in place for New York’s commercial and government insurance programs.
  • In-depth telephone interviews with health plan technical experts to gather insights and information, which helped shape the agenda for the meeting discussed above, and to follow up in greater detail on specific items or questions that arose during the meeting.