Agent Survival Guide Podcast Risk Adjustment & Finding Value Beyond Coding Changes ft. Dr. Shannon Decker
Sep 29, 2025
Dr. Shannon Decker, a value-based care consultant and CEO of VBCOne, shares her journey from teaching to healthcare leadership. She discusses the significant shift in risk adjustment models, detailing changes from V24 to V28 and their implications for Medicare Advantage. Shannon emphasizes the importance of focusing on patient quality and chronicity beyond just coding. She also provides insights on how agents can better navigate these changes for their clients while stressing the need for improved healthcare outcomes.
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Career Path Into Risk Adjustment
- Dr. Shannon Decker described her career shift from high school teacher and fitness model into health operations and risk adjustment leadership.
- She built operations experience at HealthNet, Optum, large medical groups, and then launched VBCOne in 2022 to consult on risk, quality, and total cost of care.
Risk Adjustment Is About Funding Care
- Risk adjustment ensures money follows the expected care needs of patients, not just diagnoses.
- Accurate documentation of chronic disease chronicity matters because reimbursement aligns with expected utilization.
Focus On Patient Chronicity, Not Codes
- Focus on the patient and document true chronicity rather than chasing specific codes.
- Invest the risk-adjusted funds into follow-up care and preventive actions that improve outcomes.