Risk Adjustment and Why It's Important.

What is the risk adjustment process:

  • As you visit your doctor, they report back to your insurer any diagnoses of chronic conditions, illnesses, etc.
  • We take that information along with demographic information (where you live, gender, age) and create a personalized “risk factor”
  • This risk factor is then used to adjust the payment that we receive from CMS (Centers for Medicare and Medicaid Services)
  • Risk adjustment = expectation of what your care may cost

Why its important to you:

We keep careful record of this information, which is based upon reliable and accurate records from your doctors and the facilities you visit.

This process is important to ensure that you’re getting the right type of care to live a healthy life.

We make it easy for your doctors to update your records and follow up with them, so you don’t have to.

No more, no less. Together we make sure you’re covered.

Older Asian Man
Page Last Updated On: March 4, 2021
This link will leave eternalHealth.com, opening a new window.
Continue to OptumRx
Return to eternalHealth
This link will leave eternalHealth.com, opening a new window.
Continue to CMS.gov
Return to eternalHealth
Tom Cunniffe

Tom Cunniffe

Director of Operations 

Tom Cunniffe comes to eternalHealth with over 20 years of healthcare operations’ experience, having held leadership positions in Call Center, Enrollment, Credentialing, UAT and Reimbursement teams. Tom has worked with Medicaid, Commercial and Medicare lines of business and has consistently built teams who are metrics driven with proven successful outcomes. Making sure our business strives for an efficient, best-in-class customer experience is at the center of Tom’s philosophy.

Tom has a bachelor’s degree from Fordham University and a master’s in business administration from University of Massachusetts at Amherst.

Tom Lawless

Tom Lawless

Chief Financial Officer

Tom Lawless has spent the past 20+ years building, sustaining, and growing new healthcare-related programs that balance fiscal responsibility & prudence with creativity & innovation, focusing on models of care that are novel, person-centered, and improve the social welfare of those who are served. He is very excited to continue doing so in his role as the Chief Financial Officer of eternalHealth.

Tom comes to eternalHealth from a not-for-profit, member-centric, health insurance cooperative. He helped the company continuously strive toward its dual goals of thriving financially, while keeping members at the very epicenter of its mission and service model. While there, Tom also spearheaded the creation of a brand new private, charitable foundation, which will be meaningfully giving back to those in need in the surrounding communities for years to come. Previously, Tom worked in the finance department of a successful hospice that provided high-quality care to persons experiencing their unique and poignant end-of-life journeys, assuring that the appropriate financing was always available. Tom’s career began as a civil servant in the Wisconsin Medicaid program, where he helped to create a program that expanded the institutional entitlement to care into home and community-based settings. Starting with only a blueprint in hand, the program now serves more than 57,000 frail elders and disabled adults and is considered a national model. Growing into a senior leadership role, Tom was a key architect of an innovative financing model, through which the public and private sectors successfully collaborated to better the lives of persons in great need.

Tom holds undergraduate and graduate degrees from the University of Chicago, with additional graduate work in economics completed at the University Wisconsin-Madison.

This link will leave eternalHealth.com, opening a new window.
Continue to CMS.gov
Return to eternalHealth
This link will leave eternalHealth.com, opening a new window.
Continue to medicare.gov
Return to eternalHealth
This link will leave eternalHealth.com, opening a new window.
Continue to OptumRx
Return to eternalHealth