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CHRONIC CARE MANAGEMENT

Your Risk Scores Don’t Reflect the Patients You’re Treating

Every undocumented chronic condition lowers your risk adjustment scores, shrinks your capitated payments, and makes your patient panel look healthier than it actually is. The gap between your actual patient acuity and what your data shows is costing you real money.
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THE CHALLENGE

Your RAF Scores Are Artificially Low

Risk Adjustment Factor (RAF) scores drive capitated payment rates across Medicare Advantage, ACO, and other value based contracts. Higher acuity patients generate higher payments because they cost more to treat. That math only works when your documentation captures the full clinical picture.

Most organizations know their RAF coding could be more complete. Chronic conditions go undocumented or under specified. ICD-10 Z codes that should be captured during care encounters get missed because there isn’t enough time during the visit, the right questions don’t get asked, or the data simply doesn’t make it into the record.

The result: your risk scores are artificially low. Your payments don’t reflect the actual complexity of your patient population. And the revenue you’re losing isn’t a one time hit. It compounds year over year as incomplete data carries forward into future payment calculations.

ROOT CAUSE

You’re Missing the Most Consistent Touchpoint You Have

The documentation gap isn’t just about coding accuracy. It’s about missing the most consistent touchpoint you have with your highest acuity patients.

  • CCM calls happen monthly. Office visits happen a few times a year.

    For patients with multiple chronic conditions, the monthly CCM outreach is often the most frequent clinical touchpoint they have. Every one of those calls is an opportunity to capture updated diagnoses, document condition progression, and ensure the medical record reflects reality. When your CCM program isn’t running, or when it’s running without RAF documentation workflows built in, you’re missing 12 opportunities per patient per year to get your data right.

  • Incomplete risk data distorts your entire population health picture.

    It’s not just the payment impact. When your data shows a healthier population than you actually serve, your care management programs are built on flawed assumptions. You understaff for actual acuity. You underfund interventions. And you’re surprised when outcomes don’t match your models.

  • The gap widens as value based contracts expand.

    CMS and commercial payers are steadily shifting toward risk adjusted payment models. Every undocumented HCC code today means lower baseline payments tomorrow. Organizations that build RAF capture into their CCM workflows now are compounding their advantage. Organizations that wait are compounding their losses.

OUR APPROACH

RAF Documentation Built Into Every Touchpoint

Our CCM program builds RAF documentation into every patient touchpoint. It’s not a separate workflow or an add on. It’s embedded in the call structure.

  • Complete ICD-10 Z code capture at every interaction

    Our clinical specialists use structured protocols that prompt for complete condition documentation during every CCM call. No codes left on the table.

  • Your medical record gets updated, not a separate database

    We work directly in your EHR. Documentation captured during CCM outreach flows into the patient’s permanent record, available to every clinician who treats them.

  • Evidence based, condition specific workflows

    Our protocols are designed around the chronic conditions your population carries. Diabetes, COPD, CHF, hypertension, and complex comorbidities each have tailored documentation pathways.

  • Audit ready from day one

    HIPAA compliant, SOC 2 certified, NIST compliant. Every documented encounter stands up to scrutiny.

See our full Chronic Care Management approach

RELATED CHALLENGES
PROVEN AT SCALE

Complete documentation at every touchpoint

We capture the full clinical picture so your risk scores reflect reality and your payments match your patient acuity.
99.4%
Quality KPI pass rate
HIPAA
SOC 2 & NIST compliant and audit ready
EHR
Integrated documentation at every touchpoint

Stop leaving risk adjustment revenue on the table

See how a CCM program with built in RAF documentation can capture the revenue your patient acuity supports.

Schedule a Consultation

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