Affinitē Risk Empowers Health Plans Perform Risk Adjustment In-House

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“Affinitē Risk…automates processes to transform risk adjustment into a strategic advantage. Eliminating much of the time-consuming manual input, gap analysis and remediation, and provider outreach is key to allocating resources that can improve – not merely maintain – risk scores.”

Peter Janelle
Director of Risk Adjustment
Vital Data Technology

“We serve a unique segment of a health plan's population. With Vital Data’s Affinitē™ Risk module we are able to perform HCC risk adjustment and meet 2018 compliance requirements in a timely manner. This solution sped up our efforts and reduced the cost of implementation.”

George Platt, MSOM, PAHM
Chief Executive Officer and President
Access Health Services
 
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.

Key Ways Affinitē Risk Helps You Bring Risk Adjustment In-House and Improve Operational Efficiencies


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Compute risk scores and opportunities daily at the member and provider level for either Medicare or Exchange populations on a 12-month payment year cycle.


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Achieve higher RAF for specific categories by focusing on those with the highest potential for improvement.


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Provide health plan staff with real-time, forensic analysis of risk acuity gaps and prioritize lists of “member suspects” based on a year-over-year health condition comparison and other inconsistencies in data.


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Capture supporting documentation to facilitate care gap chase discoveries for individual members within the solution.


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Engage providers with pointed interventions by patient so they can address all gaps associated with their practice.


Why Affinitē Risk Is a Key Component to Bringing Risk Adjustment In-House