How Can I Improve My Organization’s RAF Scores?

by | Apr 11, 2022 | Blog

Increasing Reimbursement with Better Documentation 

Value Based Care Organizations oversee the complex care of patients across multiple settings and interdisciplinary teams. Managing the logistics and ensuring excellent patient care is challenging enough; however, many of these organizations also receive low reimbursement, despite the care they provide. How do you fix that? By getting more accurate RAF scores. 

First, since there are a million acronyms in healthcare, let me refresh you about RAF scores. Risk Adjustment Factor, or RAF, scores look at patient demographics and medical conditions to predict the cost of the patient’s care each year. When a patient has an above-average RAF score, the payer reimburses more money for the patient’s expenses. Organizations can also see shared savings if they provide exceptional care for less than the expected cost. However, when a patient’s RAF score is lower than it should be, the reimbursement is low. 

How Does Documentation Impact RAF Score? 

With better documentation, your organization can improve its RAF scores. When documentation doesn’t fully capture a patient’s complex diagnoses and clinical needs, it can lead to an inaccurately low RAF score. The problem is, many current health tools are not designed for the collaborative workflow of modern medicine. Additionally, most tech is tied to a specific location, and this is a challenge for organizations that monitor their patients across multiple care sites, such as ACOs. 

To work around tech issues, clinicians write notes on paper, in word documents, and other sources throughout the day, and then need to enter it again into the EHR at the end of the day so that it can be properly coded. However, these notes may get lost or get only partially entered into the EHR due to time and technology constraints. Then, the patients’ conditions do not get coded properly, and their RAF scores are low. 

The good news is that there are ways to address this problem. What if clinicians could access a patient’s chart and make updates to the care plan throughout the day, instead of repeating tasks and trying to remember all the updates to add to the EHR at the end of a shift? Health tech can help. 

Care Orchestration and RAF Scores

In a pilot study at Crozer Keystone Medical Group ACO, clinicians used CareAlign’s care orchestration platform combined with novel processes to manage their workload. This helped them increase RAF scores by 18% with a $3800 increase in per patient reimbursement, compared to just $460 for the ACO’s clinicians that did not use CareAlign. View the case study here

CareAlign’s care orchestration platform allows clinicians to update their care plan throughout the day, while also giving providers a shared task list, intuitive views of data for clinical decision-making, and a platform to collaborate with the entire team. Our recent case study has shown just how effective this can be for an ACO or other value based care organization. 

Download the full case study here

Loading...