Through an accurate assessment of the patient’s health status using risk adjustment factors (RAF) score.
A RAF score is assigned in a risk-adjusted model based on a patient’s demographic factors and diagnosis codes mapped to hierarchical condition categories (HCCs). RAF scores are used as a metric to predict care utilization and financial projection for the following year for patient care.
The RAF score represents the patient population for a health care organization. This score is used to determine financial metrics and care utilization benchmarks for value-based programs.
HCCs represent the patient complexity, presenting the patient’s chronic conditions and patient care provided.
HCC specificity and compliant documentation are key to capturing the accurate RAF scores that represent the patient burden of illness.
Average RAF score baseline for an individual = 1.0
Healthy patients may have a RAF score below the 1.0 average.
Sicker patients may have a RAF higher than the 1.0 average.
HCCs present the complexities of a patient’s conditions. Managing your patient’s HCCs in a value-based world has never been more important. Or complex.
Consider the following:
In 2020 there were 19 HCC categories representing 86 chronic health conditions used to determine a patient’s RAF score. This continues to increase year after year.
Complex? Yes, but important as value-based health care continues to expand across patient populations. HCCs provide the complete clinical picture of the patient and the patient’s chronic condition.
Specificity can make a difference. The ability to document greater specificity can have an impact on RAF scores and subsequent reimbursement.
Patient with diabetes
Category: HCC 19
Description: Diabetes without complications
Patient with diabetes and documented complications
Category: HCC 18
Description: Diabetes with complications
CMS HCC 19 (example 1) shift to CMS HCC 18 (example 2) raised the individual patient’s RAF score by 0.197 which can increase the potential reimbursement impact*
*Actual impact is based on the health care organization’s plan
3M HCC Management is a closed-loop solution that uses artificial intelligence (AI)-powered computer-assisted physician documentation (CAPD) technology to deliver efficiency in identifying and documenting HCCs, thereby helping ensure an accurate RAF score representing the patient.
The physician has the most relevant patient information available upon opening the patient chart
During the visit
The point of care nudges reduces the need for additional “after hours” administrative tasks
Calculates RAF scores for all patients in a facility’s population helping auditors identify gaps from year to year, in addition to presenting a clear picture of the patient population
Let's see how we can work together to optimize your organization today!
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