A Toolkit for Risk Adjustment Success: Evolent and ACO Partner Share Their Strategies

August 16, 2021

Thoroughly and accurately coding a patient's health conditions sets the stage for so many health care improvement activities, from prioritizing the right individuals for wellness visits to closing care gaps and delivering comprehensive care management. It's also critical for getting appropriately reimbursed for the severity of disease that providers manage.   

Writing in the March/April 2021 issue of The Journal of Medical Practice Management, risk adjustment experts from Evolent Health Services and Best Care Collaborative, a Next Generation Accountable Care Organization, detail how we collaborated to more thoroughly capture and document patients' disease burden. 

Their results: Between 2018 and 2019 the ACO's risk adjustment factor increased by 4.1%, generating an additional $2.5 million per 1,000 ACO members. The increased coding accuracy is credited with facilitating other downstream improvements, as the team identified and reached out to prioritized patients:

  • $258,334 per 1,000 members from increased office visits
  • 11.2% decrease in Emergency Department visits ($100,915 in savings)
  • 11.9% drop in inpatient admissions ($1,756,869)
  • A survival benefit of 6% for patients

Read the journal article for details to learn about the tactics and tools that drove these improvements. 

Posted with permission from The Journal of Medical Practice Management®, Volume 36, Number 5, pages 260-265, Copyright 2021, American Association for Physician Leadership®, 800-562-8088, www.physicianleaders.org

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