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Use case Risk Adjustment

Leverage risk adjustment analytics for accessible, quality care

Risk adjustment analytics provide 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.

Ready to get the full picture with risk adjustment analytics?

The Challenge

Insufficient data causes unreliable risk adjustment and poor patient and provider outcomes

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 gives an incomplete picture of the disease burden of a patient population. These data gaps represent missed opportunities for more accurate documentation and result in lower quality care and lower reimbursement for provider organizations.

The solution

Utilize risk adjustment analytics to deliver a more comprehensive view of 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.

Advanced risk adjustment analytics close risk gaps with accurate, comprehensive data.
Featured Applications

Risk adjustment analytics 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.

Arcadia Foundry

Healthcare Data Model

Healthcare data model built by analysts, for analysts

Arcadia Vista

Analytics Dashboard

Business intelligence software built for healthcare organizations

Arcadia Bindery

Healthcare Reporting for Providers

From provider reporting to efficient healthcare data analysis

Arcadia Desktop

Point-of-Care Insights

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

Arcadia Assess

Provider-Payer Collaboration

Simplify provider-payer collaboration for risk and quality gap closure

Arcadia SDoH Package

Unified SDoH data

Improve health outcomes by streamlining the way you identify populations most in need of care

Customer Story

How healthcare data insights improve risk scores

Ascension Illinois / AMITA Health ACO / CIN explains how data insights led to improved year-over-year risk scores and the ability to treat critical populations.

Latest Resources

Risk adjustment analytics 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 risk adjustment analytics unearth the most meaningful data, so your team can spend more time on what matters — using insights to drive healthier networks and healthier patients. Reach out to us to learn how we can help you accelerate insights.

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