System of changing capitation rates paid to providers of medical services given to a group of members whose medical care has higher medical costs than average. This may be due to medical condition, geographical location, age, gender, ethnicity, or race. Also called risk load or risk adjuster .

Group of insured individuals who have a similar risk to the insurance company. Common risk classes are standard, preferred, nonsmoker, substandard, and uninsurable.

1. Provider’s agreement with a managed care plan to deliver medical services to members for a determined, fixed payment without knowing the cost of the services. The provider is responsible for managing the medical care and risks losing money if total expenses are more than the predetermined amount of funds. 2. In a Medicare risk contract, the federal government sends monthly fixed payments to the managed care plan for services given to Medicare beneficiaries who join the plan and agree to receive all medical care through the plan. The plan is at risk for services regardless of the extent, expense, or intensity of services rendered. Sometimes an additional fee may be paid by each enrollee. Medicaid beneficiaries enrolled in risk contracts are not required to pay monthly premiums.

System to redistribute premium income with many insurance companies to diminish the risk when selecting people to insure.

In a managed care plan, this phrase refers to a decrease of a risk (loss foreseen) in the group of members.

Situations that influence an individual’s health and may cause illness including heredity, sex, race, age, biological factors, environmental factors, and behavioral factors (smoking, inactivity, response to stress).

MEDICAL, US: Individual responsible for clinical and administrative procedures used to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of loss to the facility or organization.
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UK: Person appointed to carry out risk management on behalf of an industrial or other organisation. Risk managers may join the Association of Risk Managers in Industry and Commerce (AIRMIC) or the Institute of Risk Management or ALARM if in the public sector.
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Risk managers advise organizations on any potential risks to the profitability or existence of the company. They identify and assess threats, put plans in place for if things go wrong and decide how to avoid, reduce or transfer risks.
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The individual in an organization responsible for evaluation of the organization’s exposures and controlling those exposures through such means as avoidance or transference, as to an insurance company.

Risks are based on documentation of the presenting problem(s), the procedure(s) performed, treatments ordered, and other possible management options.