Regional Managed Care Organization Discovers Member Gaps and New RAF Opportunities with Advanced Coding Analytics

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Despite more than 76% of members experiencing chronic conditions, the organization was struggling to capture accurate HCCs. By implementing Episource’s advanced analytics technology, Episource Analyst, they increased their RAF by over 30% after just two years of implementation.

The Challenges:

• Missed year-over-year chronic conditions. Patients with known chronic conditions
  such as diabetes, heart disease, etc. were not being captured as such on a year-
  over-year basis due to poor coding efforts or a lack of patient visits.
• Ineffective communications with high-risk patients. A lack of visibility and limited
  communications strategy meant that they had no way to move their chronic
  patient population towards necessary doctor’s visits.