Maximizing Risk Adjustment

Accurate Data. Strategic Insights. Optimized Reimbursements.

Reshaping Risk Adjustment for Precision Reimbursements

In risk adjustment, precision isn’t optional—it’s critical. Health Plans rely on accurate risk stratification & coding to secure accurate reimbursements, support value-based care models, and effectively manage care. Yet, inconsistencies in data, coding errors, and gaps in clinical history can cost millions in lost revenue and undermine member care.

The Challenges Health Plans Face in Risk Adjustment

Incomplete or Inaccurate Member Documentation

Chronic conditions often go undocumented due to incomplete data capture or improper coding. These gaps not only result in inaccurate risk scores but also leave members at risk of inadequate & untimely care.

Lack of Predictive Insights

Health Plans miss opportunities to proactively identify members with chronic conditions, collaborate with providers and close risk gaps when solely relying on historical claims data for insights.

Inefficient Retrospective Processes

Manual chart retrievals & reviews combined with retrospective audits are time-consuming, resource-intensive, and prone to errors. They also prevent health plans from truly adopting a more concurrent or prospective risk management process.

How We Solve It

Empowering Accurate, Real-Time Risk Adjustment

Unified Member Records

Our FHIR-native Health Data Management Platform (HDMP) creates a golden member record by integrating and curating real-time clinical & claims data from diverse sources. This ensures a complete and accurate member history, enabling precise identification of diagnoses codes and real-time risk management.

Real-Time Analytics

With our HDMP bringing real-time clinical data into the Payer’s environment, Payers are able to run analytics on fully integrated longitudinal member records in order to more granularly stratify their population and more effectively collaborate with providers.

Bi-Directional Data Exchange

Through our Common Data Model and Bi-Directional APIs, Payers gain access to universal, high-quality data that can be exchanged with providers and downstream applications. This fosters real-time collaboration and enhances care coordination – directly impacting risk adjustment efforts.

Discover how precision risk adjustment  drives value for Health Plans

Why It Matters

Precision in risk adjustment doesn’t just secure reimbursements—it drives operational excellence:

Improve Member Outcomes

Identify at-risk members and proactively close risk gaps.

Optimize Revenue

Capture the full scope of risk for fair, timely & accurate reimbursements.

Boost Compliance

Ensure alignment with CMS guidelines and audit readiness.

Reduce Administrative Burden

Leverage automation and interoperability to streamline workflows.

Learn how we tackle interconnected challenges for Health Plans:

Explore More Problems We Solve

Data Infrastructure

Build a foundation of clean, reliable, and interoperable data.

Quality Improvement

Drive performance in STAR ratings, HEDIS, and more.

Population Health Management

Engage members and manage risk at
scale.

Drive Accuracy and Efficiency in Risk Adjustment

Unlock the full potential of risk adjustment strategies with data-driven precision and proactive insights.

Schedule a Consultation

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