About the primary care group
A primary care group that specializes in caring for older adults, keeping them healthy and helping them transition into active seniors. It delivers a patient-focused, value-based model of care.
Claims-only data was understating risk
Relying on claims data alone left the group with an incomplete picture of patient risk. The group faced these challenges:
Reviewing charts to capture embedded conditions
IKS Health began with risk stratification and patient population identification, prioritized against predefined variables and the group’s risk arrangements with payers. From there, IKS Health clinicians conducted a detailed review of the last two years of patient records to capture recent HCC-eligible chronic conditions. They then shared non-validated HCC recommendations and inferred diagnoses for physician review, with bi-directional feedback so clinicians and physicians could refine the picture together.
By reading the full record rather than just the claims, the group captured risk more accurately and turned it into measurable return. Across more than 12,500 charts reviewed, IKS Health clinicians identified chronic diseases that had been treated, inferred, or embedded in the records but never correctly documented, bringing them into the chart where they count.
0.23
Improvement in RAF score per patient
0.46
More potential HCCs per chart
$38
Gain in per member per month through accurate RAF capture
14x
Return on program investment
