Successful Risk Adjustment Improves Gap Closures: A Real-World Client Success Story of a Veradigm Partnership

Thought Leadership  |  06 March 2023

Featured Client Story

Successful risk adjustment plays a critical role in health plans’ operations. It helps ensure their beneficiaries’ health conditions and demographics are accurately documented. In doing so, it helps ensure that the health plan responsible for those beneficiaries is appropriately compensated for their coverage. However, these are not the only roles of risk adjustment. Risk adjustment is also a critical tool for identifying potential gaps in care among beneficiaries. It enables payers to help ensure their beneficiaries develop high-quality connections with providers, allowing providers to document and promote patients’ health and care. These connections help ensure providers proactively manage patients’ health and that members receive the care they need. Research shows that engaged members are less costly and experience better health outcomes than non-engaged members.

Payers face numerous challenges navigating the risk adjustment landscape. Read on to learn how one large Regional Health Insurer overcame numerous challenges to strengthen their Risk Adjustment program.

The Regional Health Insurer is a health and wellness company serving more than 3 million individuals in the northeastern U.S. This paper tells the story of their success in the risk adjustment arena, improving their provider engagement experience and improving their risk adjustment processes and outcomes—success achieved through partnership with Veradigm. This paper provides insight into how Veradigm and the Regional Health Insurer invested in people and processes, as well as product solutions, working together every step of the way to achieve visible success, including:

  • Closure of appropriate risk adjustment gaps
  • Clinician feedback on conditions not applying to members
  • Achievement of more accurate and complete risk scores, allowing them to deploy the right interventions, with the right providers, at the right times

Learn how Regional Health Insurer’s goals were achieved or exceeded year upon year with steadily improved completion of provider alerts through an ongoing partnership with Veradigm, a pairing for success.

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