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Usecases riskadjustment
Use case Risk Adjustment

Predictable risk adjustment is vital for accessible, quality care

Risk adjustment is a statistical method that seeks to predict a person’s likely use and costs of health care services. The methodology equates the health status of a person to a number, called a risk score, to predict healthcare costs.

Risk adjustment is critical to adequately compensate health insurance plans so they maintain coverage and access to care for beneficiaries likely to incur higher than average costs. Providers also play an important role in risk adjustment as the health plans will look at diagnosis codes that providers submit on claims to understand a patient’s risk factor.

The Challenge

Poor data leads to unreliable risk adjustment and poorer outcomes for patients and providers

Diagnosis data contained in medical claims is the primary mechanism for communication between providers the health plans and should be comprehensive of the conditions positively assessed during each visit. But only using claims data and select chart audits provides an incomplete picture of the disease burden of a patient population resulting in missed opportunities for more accurate documentation, resulting in lower quality care and lower reimbursement for provider organizations.

The solution

With a more comprehensive view of patients, providers can close more risk gaps and improve population health

When patients’ health history is more accurately documented, providers and leadership engaged in risk adjustment get a full understanding of their performance and opportunities. This makes it easier for providers to identify and assess suspected diagnoses at the point of care resulting in more accurate documentation. Increased reimbursement from payers can be reinvested back into better patient care.

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Featured Applications

Risk adjustment applications

Identify and assess suspected diagnoses at the point of care, simplify coding and documentation, and increase transparency and collaboration to close risk gaps across your network.

Healthcare Data Model

Healthcare data model built by analysts, for analysts

Analytics Dashboard

Business intelligence software built for healthcare organizations

Healthcare Reporting for Providers

From provider reporting to efficient healthcare data analysis

Point-of-Care Insights

Find health insights at the point of care using your existing EHR workflows

Provider-Payer Collaboration

Simplify provider-payer collaboration for risk and quality gap closure

Latest Resources

Risk adjustment insights to improve patient outcomes

A single data source with a panoramic view

The information that will accelerate your healthcare system’s success is buried right at your fingertips. Arcadia’s platform unearths the most meaningful data, so your team can spend more time on what matters — using analytics to drive healthier networks and healthier patients. Reach out to us to learn how we can help you accelerate insights.