HCC / RISK-BASED SERVICES
Understanding UASI's Risk Adjustment Maturity Model
Did you know optimizing RAF scores by just 0.1 can add $1 million to your bottom line?*
*Based on a population of 10,000 lives
Transform Your Healthcare System with Value-Based Care Excellence
UASI is Trusted by 200+ Healthcare Systems
Stats & Facts:
Medicare Advantage Enrollment:
In 2021, over 26 million people were enrolled in a Medicare Advantage plan, accounting for 42% of the total Medicare population
CMS Projections
By 2030, the vast majority of Medicaid beneficiaries will be in a care relationship with accountability for quality and total cost of care
ROI Potential
For every 0.1 improvement in RAF scores, an organization can expect an increase of $1 million based on a population of 10,000 lives
Elevate your financial outcomes through strategic risk adjustment optimization.
Discover the stages of UASI's Risk Adjustment Maturity Model, designed to guide healthcare organizations towards optimized risk adjustment processes. Explore how each phase enhances accuracy, efficiency, and compliance, ultimately driving improved patient outcomes and financial performance.
Explore
Discover Hidden Opportunities
- Where is the Opportunity? Uncover areas with the greatest potential for improvement.
- Assess the Impact: Evaluate the significance of each opportunity.
- Data Accuracy: Ensure your data accurately reflects your population’s health status.
Define
Strategize for Success
- Identify Major Opportunities: Pinpoint where the biggest gains can be made.
- Patient Prioritization: Decide which patient groups to focus on and the immediate actions required.
- Resource Allocation: Determine the people, processes, and tools necessary to achieve your goals.
Implement
Execute with Precision
- Assemble the Right Team: Ensure you have the right people, processes, and tools for value-based care (VBC).
- Holistic Program Establishment: Follow strategic steps to develop a comprehensive program.
- Sustainability and Compensation: Guarantee that your team is properly compensated and your program is sustainable.
Optimize
Continuous Improvement
- Performance Monitoring: Keep track of your performance metrics to ensure ongoing success.
- Evaluate Effectiveness: Regularly assess whether your people, processes, and tools are delivering the desired results.
- Focus Areas: Identify where to concentrate your efforts for maximum impact.
- Close the Loop: Ensure all processes are interconnected and improvements are continuously made.
Managing Risk-Adjusted Population
Case Study
Our Risk Adjustment Organizational Maturity Model benchmarks your organization’s ability to manage a risk-adjusted population effectively. We help you identify opportunities within your risk-adjusted population, improve RAF scores, and conduct regular HCC audits to measure success.
Data Analysis
The move to value-based care is a challenging one for most health systems as it involves working differently.
Establish a Program
Achieving success with value-based care is a marathon, not a sprint.
Assessments
We can help you get started with the people, processes and technology needed for success.
RAF Vue™️
Our measured approach can get you started to gain an ROI quickly and expand as the value is achieved.
Delivering Pragmatic Mid-Rev Cycle Solutions for Long-Term Impact
As the healthcare landscape shifts towards value-based reimbursement models, accurate coding becomes crucial in optimizing revenue cycle performance. UASI is at the forefront, providing comprehensive solutions to address risk adjustment and hierarchical condition categories (HCCs).
Contact UASI if you’d like to speak with one of our HCC risk adjustment experts for guidance on your next steps.
Get Visibility.
Optimize Workflow.
Improve RAF Scores.
Unlock the full potential of your healthcare organization with UASI’s comprehensive risk adjustment and HCC offerings. Our solutions are designed to explore opportunities, define strategies, implement changes, and optimize outcomes, ensuring you stay ahead in a value-based care environment.
Our Services & Solutions
Risk Adjustment Analysis
- Initial Assessment: Using UASI’s proprietary software tool to identify risk adjustment opportunities, including patient risk adjustment (RAF) scores for a defined population.
- Data Analysis:
Application of proprietary algorithms to analyze claims data and identify trends indicative of missed or inaccurate HCC capture.
Risk Adjustment Program Assessment
- Baseline Evaluation: Comprehensive assessment of provider documentation and HCC coding to identify opportunities for accurate patient risk adjustment scores.
- Process Improvement: Exploration of current documentation practices and organizational structures to identify improvement opportunities.
Outpatient CDI Program Implementation
- Program Execution: Applying best practices to initiate a successful, sustainable outpatient CDI program, including installation of UASI proprietary software tools and staffing support.
- Full Support: Providing full-time Outpatient CDI Program Directors and ongoing staffing to ensure program success.
Ongoing Monitoring & Program Optimization
- Continuous Improvement: Custom-designed services to support and enhance your outpatient CDI program with updated risk analysis and regular audits.
- Performance Metrics:
Quarterly risk assessments and analysis of current reports to identify opportunities for improvement.
Education and Tools
- Risk Adjustment/HCC Education: Comprehensive training on risk-adjusted payment methodologies and documentation requirements.
- RAFVue Software: UASI’s proprietary tool installed for use in outpatient CDI programs, with training provided for effective usage and reporting.
Introducing:
Boost Efficiency and Accuracy Instantly with RAF Vue™️
No EMR Integration Needed
Implementing advanced technology solutions, such as our proprietary software RAF Vue™️, can significantly enhance efficiency and accuracy. Instant insights into chronic code capture and recapture opportunities allow for quick identification of patients with the greatest treatment and financial impacts. With a centralized, patient-level view and automatic calculation of reported and potential RAF scores, RAF Vue™️ generates comprehensive reporting at the patient, provider, and reviewer levels. Best of all, RAF Vue™️ can achieve immediate go-live without requiring EMR integration, reducing the technological burden on your practice.
RAF Vue™
RAF Vue™ At-A-Glance
- Instant Insights: Quick identification of chronic code capture and recapture opportunities.
- Centralized Patient-Level View: Highlight patients with the greatest treatment and financial impacts.
- Automated Calculations: Reported and potential RAF scores.
- Immediate Action: Enabled immediate action to capture upside opportunities.
Real-World Results
- 48000 Records Analyzed
- 3500 Patients Identified in Risk-Adjusted Population
- $24M Financial Opportunity Identified
Performance Metrics
- 39% HCC Recapture Rate vs. 85% Industry Goal
- 1200 Patients Lost from last year to this year
- 500+ Patients without an annual wellness visit this year
Key Features
- Comprehensive Reporting:
Generates reporting at the patient, provider, and reviewer levels.
- Seamless Integration: Achieve immediate go-live without EMR integration.
The numbers you need to know
48,000
records analyzed
$24mm +
Over $24 million dollars in financial opportunity
3,500
patients identified in the risk-adjusted population
500+
patients without an annual wellness visit this year identified