Medicare Patient Risk Stratification
Using the Precise Health Risk Compass™ for RAO, a primary care practice on the West Coast with 22 providers analysed claims data for 10,500 Medicare patients. The top 30% of high-risk patients accounted for 70% of the overall risk and revenue potential. These patients were selected for prospective review (PR) and supported with targeted interventions yielding cost savings and better ROI for PR.
THE CHALLENGE
Inefficient Chart Selection Methods Lowers ROI from Prospective Review.
Optimal chart selection depends on precision health risk analytics.
Overlooking HCC linkages lowers revenue potential.
Not accounting for ICDs with prior covered HCCs can be misleading
Proven Approach
Use VBC’s Precise Health Risk Compass™ for RAO to achieve better results by
- Analyzing ICDs from current and past claims with patient demographics
- Computing RAF scores and assessing HCC
- Forecasting Medicare payments
- Segmenting patients into various risk tiers.
- Generating actionable revenue analysis reports.
- Prioritizing CDI and other efforts to optimize coding.
Better Outcome
Achieve 40% lower Prospective Review costs with 30% less documentation,
gaining 18% or more in ROI.
- Reduce PR costs by prioritizing charts of the most at-risk patients.
- Decrease clinical documentation burden from duplicate and dropped HCCs.
- Greatly increase the positive impact of targeted interventions.
Key Takeaway
Precise risk stratification across an entire Medicare population makes prospective review highly efficient and more effective.
Call-to-Action
Ready to transform your prospective review and risk adjustment strategy? Contact Us to learn how Precise Health Risk Compass™ for RAO can sharpen your focus on high-value patient charts, slash PR costs, and boost your overall ROI.