Clinically Enhanced Risk Adjustment

Use EHR data to improve risk measurement and adjustment accuracy for Medicare, Medicaid, and commercial contracts using HCC, CDPS, and the Johns Hopkins ACG algorithms.

Risk Navigator is fully integrated into Arcadia Analytics to make risk gap information available at the point of care, where risk gaps can be reviewed, addressed and documented by the provider.

  • Use automated EHR interfaces to perform thousands of chart audits in minutes.
  • Identify opportunities to more accurately document patient risk, increase reimbursements, and improve patient care.
  • Deep-mining of unstructured data powers enhanced risk algorithms – HCC, CDPS, and Johns Hopkins ACG.
  • Real-time risk profiling and full progress note availability.

Interested in learning more?  Get started.

Why claims-based approaches to risk are deficient – and what to do about it. 

The traditional approach to risk adjustment uses claims-based data, but this approach to calculating clinical risk is deficient – and it can put an organization at financial risk.  Claims-based information is incomplete, slow, misaligned with provider data, and often not relevant at the point of care.   Luckily, EHR data can close the gaps.

Read our blog post.

The 5 actionable risk gaps that impact revenues by $100-200 PMPY or more

Risk documentation gaps occur at multiple stages in the claim process when information is not transferred from one step to another.  This occurs frequently; due to the nature of the process by which providers record information and bill payers, only a limited subset of the data captured during the visit makes it on to the claim  – resulting in inaccurate risk-adjusted premium payments.

Medicare Advantage plans may be missing out on $100-200 PMPY in retrospective risk adjustment – and even larger opportunities within the current year.   Our whitepaper explains how risk documentation gaps occur, how EHR data can augment claims-based HCC risk adjustment for more accurate capitation under Medicare Advantage, and how organizations can take action on that information.

Get the whitepaper.

Revolving Risk

A Data Visualization

Risk resets each year, meaning that healthcare providers need to provide annual documentation of chronic conditions for those conditions to be considered when a risk-adjusted premium is calculated.  Arcadians Omar Nema and Michael Gleeson visualized this process over the course of a year for one practice serving 42,705 patients across 166,440 visits.

They found some surprising results.  Patient “Jane Smith” was seen 35 times by 5 different clinicians throughout the year.  Those clinicians slowly improved Jane’s documented risk profile – but never got more than 70% complete.   To learn more, visit the Arcadia Data Gallery and explore this data visualization.

Explore the data visualization.