Risk Adjustment

Medicare HCC Prevalence by Specialty

Most healthcare organizations focus their risk adjustment efforts on finding their members’ diagnoses through primary care physicians. However, when PCPs miss suspected health conditions, organizations can target specialists to optimize their retrieval and coding results.

Analyzing nearly 20,000 records of historical coding data, we find certain specialists are better targets depending on the health condition. Healthcare organizations will increase their success rate when they know which specialists are diagnosing which HCC codes.

On the dashboard below, you can select any HCC and see which specialists are most likely to document the diagnosis for it. Directing your retrieval efforts of specific HCCs towards different types of specialty providers can lead to improved results in capturing your population’s health risks.



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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider