Transforming Risk Adjustment for Senior Care: How a Leading Health Plan Improved HCC Gap Closure by 14% with Innovaccer

When health plans manage thousands of lives across fragmented data systems, coding gaps become revenue leaks and care quality suffers. A leading Texas health plan, partnering with over 1,000 senior living facilities, faced this challenge daily until it discovered a smarter approach to risk adjustment. With the implementation of Innovaccer's InNote solution, this health organization changed its risk adjustment strategy and brought precision back to where it matters most: accurate RAF scoring and proactive patient care.

What Does This Case Study Reveal?

This study provides a roadmap for health plans struggling with disparate data sources and missed HCC opportunities. It demonstrates how health plans can improve financial performance and enhance care coordination by adopting a systematic approach that includes:

• Real-time HCC gap identification during patient encounters
• Elimination of dependencies on retrospective chart reviews
• Integration of 12 disparate data sources into unified patient views
• Point-of-care documentation with intelligent coding prompts
• Automated compliance with evolving CMS regulations

Measurable Results

• 14% improvement in MA Plans HCC gap closure
• 1,673 additional RAF points gained across programs
• 10,497 dropped codes successfully recaptured via claims
• 99% of HCC improvements from previously missed opportunities