Risk Adjustment Analytics Solutions

Our industry-leading risk adjustment technology, combined with ongoing support, analysis, and score gap interventions, is designed to help our partners improve quality of care, increase revenue, and meet compliance guidelines.

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Submit Accurate, Timely Data to Help Drive Revenue

risk adjustment strategies expert partner

Risk adjustment strategies require an expert partner

For healthcare organizations, the analysis of risk scores using the specific risk-adjusted model Hierarchical Condition Categories (HCCs) — as defined by the Centers for Medicare and Medicaid Services (CMS) for Medicare and ACA-Commercial models and state-based Medicaid programs — can be difficult.

Through a collaborative partnership, Change Healthcare can assist in applying artificial intelligence analytics to help close your associated risk gaps. We leverage your data within our proven platform to help you take measures that can help reduce your risk scores, improve revenue, and impact the quality of care for your membership.

identify risk adjustment factor score gaps

Identify risk adjustment factor (RAF) score gaps

Our industry-leading advanced analytic engine extends beyond claims data analytics, incorporating alternate data sources, such as pharmacy and care management data, to identify all possible risk gaps.

Our proven team provides analytic support and deep risk adjustment expertise to interpret your risk score trend data. Together, we help you create the most effective prospective and retrospective risk adjustment strategy.

Improve Risk Adjustment in a Compliant Manner

Risk Score Trending
Detailed metrics

Monitor risk score trends and related metrics, such as percentage of members with HCCs, average risk score, and expected risk score (gaps) at the member and provider level.

Data Transparency
Comprehensive view of member and provider data

View all risk-adjusting data for members and providers, including claims, coding results, assessment data, provider diagnosis distribution and more.

Risk Project ROI
Ongoing status updates

Review and evaluate project results within our RISK View™ platform. Examine reporting of analysis results, including projected and final ROI.

Advanced Analytics & Targeting
Access to retrospective and prospective lists

Examine retrospective and prospective targeting lists using demographic data, pharmacy data, self-reported conditions, and care management information. For partners utilizing our chart retrieval and coding services, or member engagement solutions, chase lists and coding results are integrated.

Change Healthcare products are tools for use by health plans, which have ultimate responsibility to ensure diagnosis and encounter data submitted to government risk adjustment programs are accurate and complete. Health plans should consult with their own legal counsel regarding appropriate risk adjustment data collection, validation, and compliance programs. Any financial results and returns on investment described herein are illustrative and not a guarantee of any future performance. Change Healthcare’s fees are not determined based on financial results.

Solutions We Provide

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