Enrollee Health Assessment Program and Commercial Risk Adjustment

  • What is commercial risk adjustment?

    Commercial risk adjustment was established as part of the Affordable Care Act to stabilize risk for individual and small group plans inside and outside of the Exchange marketplace. It helps carriers offer various plans to meet the needs of a diverse population and is administered either by individual states or by the Department of Health and Human Services.

    What is the Enrollee Health Assessment Program?

    Premera's Enrollee Health Assessment Program supports members with chronic conditions by:

    • Encouraging members to select a primary care provider (PCP)
    • Asking PCPs to participate in the program and complete an Annual Health Review visit for identified members
    • Encouraging participation in Premera’s (or a provider’s) care management program
    • Developing tools to help providers with complete diagnosis coding and medical record documentation

    Resources for providers

    Here are some Enrollee Health Assessment (EHA) Program resources for providers and staff:

    • Understanding patient communication about the EHA program

    For more information

    If you have questions, please call Physician and Provider Relations at 877-342-5258, option 4, or email ProviderEngagementTeam@premera.com.