In a perfect world, risk-adjusted premiums would always be accurate. But information loss creates risk gaps, where patient conditions are either unknown or undocumented.
EHR data can help healthcare systems close the gaps, supporting better patient care while protecting against the financial risks of inaccurate risk-adjusted payments. For a Medicare Advantage plan, this can mean $100-200 PMPY in retrospective revenue and $1,000-2,000 PMPY in prospective revenue. And, EHR data can also help a system protect against audits and penalties associated with excessive documentation or “overcoding”.
Arcadia uses aggregated EHR and claims data to identify 5 actionable risk gaps that can be closed retrospectively for a prior service year, closed within the service year, and/or addressed prospectively. To learn more about finding and closing the gaps that can impact patient care and premium accuracy, download our whitepaper Improving HCC Risk Accuracy with EHR Data: An Action Plan for More Accurate Capitation Under Medicare Advantage. A link to download the whitepaper will be emailed to you immediately.