Health Plans Rely on Affinitē Risk™ for Risk Adjustment Insights and Efficiency

Designed by risk adjustment experts, Affinitē Risk provides high-value insights into member-specific gaps, risk scores and provider performance.

Managing member risk scores can be challenging. For starters, periodic updates to the risk adjustment models require changes to your plan’s method for estimating risk scores. If these updates are not addressed, your plan may be missing opportunities to capture diagnosis data, which could negatively impact your risk score.

Another factor is the complexity of properly coding claims to accurately reflect the acuity of an individual member’s health during the year. Providers may not fully or accurately document a member’s chronic health conditions – which may lead to underreporting of diagnosis data and a lower risk adjustment factor (RAF). Also consider that your staff might spend too much time closing low priority gaps. This inefficiency could negatively impact your plan's overall risk score.

Vital Data Technology’s Affinitē Risk module solves these challenges by providing a cloud-based solution capable of instantly performing real-time identification and prioritization of gaps for investigation – directly aligned with your plan’s highest priority conditions. Furthermore, risk adjustment teams have deep-dive capabilities to see member-specific medical records streamlining their medical record review and abstraction process. Supplemental data can be added directly to Affinitē Risk and is formatted with the required data elements for encounters submission.

The result is a greater positive impact on your plan’s Risk Adjustment Factor.