Improved RAF Score and Increased Revenue with IKS Clinical Chart Review
Client Profile:
A physician-led primary care group serving for more than 15 years, specializes in caring for older adults, keeping them healthy, and transitioning them to healthy active seniors.
Challenge:
- Insufficient documentation of treated conditions leading to inaccurate risk capture
- Incomplete diagnosis leading to missed/inaccurate treatment plans
- Missed collection opportunities and revenue loss due to focus only on claims data to identify potential/new hierarchical condition categories (HCC)
Approach:
- Risk stratification and patient population identification, based on risk arrangements with payers, was prioritized according to predefined variables
- Conducted a detailed review of the last two years of patient records to capture recent HCC eligible chronic conditions
- Shared non-validated HCC recommendations and inferred diagnosis by IKS clinicians for physician review and bi-directional feedback
Results:
- IKS Health clinicians identified chronic diseases which may have been treated, inferred, or embedded in medical records, but not correctly documented in the chart
- 1.72 new potential HCCs accepted per patient
- New HCCs accepted in 63% of patient records
- Achieved 69X return on program investment
- IKS Clinical Chart Review program led to a 0.43 improvement in risk adjustment factor (RAF) per patient
To learn more about IKS Health Value-Based Care, contact us today at info@ikshealth.com.
