Risk Adjustment

RISK ADJUSTMENT SOLUTIONS BUILT FOR PHYSICIANS

Evolent Risk Adjustment is a comprehensive prospective and retrospective risk adjustment solution built with physicians and practices in mind. We optimize discovery, improve documentation accuracy and increase clinical quality by integrating and automating the risk adjustment process seamlessly into physician workflows. This solution was designed to complement a full suite of ongoing value-based initiatives which can be overwhelming for providers.

OUR SOLUTIONS

Our prospective solution engages more physicians by implementing tools and techniques that make it fast and easy to document chronic conditions.

 

Our retrospective solution reduces coding errors by applying NLP (Natural Language Processing) technology to evaluate 100% of available medical data.

PROSPECTIVE RISK ADJUSTMENT

SUSPECT CONDITION GENERATION

Generates provider-level list of undocumented conditions prioritized by risk significance

EMR INTEGRATION

Eliminates PAF sheets by bringing risk adjustment documentation workflow into the host EMR

PHYSICIAN AND PLAN PERFORMANCE REPORTING

Highlights care gaps, quality improvement and provider performance opportunities on key RA metrics

 

SINGLE PAF ACROSS PAYERS

Builds and presents physicians with a single and simplified Patient Assessment Form (PAF) to replace multiple, complex sheets

WEB-BASED PHYSICIAN TOOL

Offers physicians an electronic alternative to paper-based PAF sheets

CMS SUBMISSION SUPPORT

Eliminates administrative burden and ensures accuracy

RETROSPECTIVE RISK ADJUSTMENT

AUTOMATED NLP CHART REVIEW

Reviews 100% of available medical data to uncover HCC opportunities and associated documentation

RAPS / EDPS FILE SUBMISSION SUPPORT

Assists with CMS-compliant file submission

 

CODER WORKFLOW TOOL

Enables fast, accurate and compliant coding through tech-assisted chart review

RADV AUDIT SUPPORT

Prepares for and conducts mock audits to alleviate audit risk

BOTH PROSPECTIVE AND RETROSPECTIVE

DATA INTEGRATION

Takes in structured and unstructured EMR, CMS, Claims, MMR and MOR data

TRAINING AND SUPPORT

Helps physician teams, office staff and managers understand the basics and benefits of risk adjustment

SIGNIFICANT ROOM FOR IMPROVEMENT

Most risk adjustment programs achieve 30-50% physician engagement, causing many documentation and coding opportunities to “leak” into retrospective or to be inaccurately coded. Much higher engagement rates in the 65-80% range are possible with the right mix of incentives, tools and education.

Retrospective initiatives rely on analytics to surface documented coding opportunities. However, “traditional” analytics can only see 20-30% of available medical data because it is contained within unstructured fields. Natural Language Processing (NLP) analytics reviews unstructured data to surface coding opportunities typically missed.