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Advance Possibility

Patient-Centric Approaches to Risk Adjustment

March 25, 2024

In today’s rapidly evolving healthcare landscape, the concept of patient-centric care is gaining increasing attention. The industry is seeing a greater emphasis on value-based care which fundamentally shifts the focus from a traditional fee-for-service model to one that prioritizes delivering high-quality care while controlling costs and improving patient outcomes. This approach emphasizes the importance of patient-centricity, where the individual patient’s needs, preferences, and overall experience take center stage. One area where this approach holds immense promise is in risk adjustment, a crucial aspect of healthcare management aimed at accurately assessing and managing patient risk factors. 

Understanding Patient-Centric Care in Risk Adjustment

Patient-centric care in risk adjustment entails redesigning care plans and strategies to prioritize patients as individuals, with a focus on their success, satisfaction, and overall well-being. This approach recognizes that each patient is unique, with specific needs, preferences, and circumstances that must be considered when assessing and managing their health risks.

Practical Steps to Implementing Patient-Centric Risk Adjustment

Transforming to a patient-centric model of risk adjustment requires a systematic and comprehensive approach. Here are some practical steps healthcare organizations can take to embrace patient-centricity in risk adjustment:

1. Change Your Mindset: Initiate a fundamental shift in organizational culture and mindset to prioritize patient needs and experiences across all departments and systems.

2. Journey Mapping: Understand the patient’s journey from start to end, and set goals to measure the effectiveness of patient-centric risk adjustment strategies.

3. Advance Possibility with Technology and Expert Teams: Leverage robust tools and data-driven insights to engage with patients more effectively, streamline processes, and enhance the overall patient experience. 

4. Embrace Patient Voices: Patients offer invaluable insights into treatment priorities and needs, yet challenges persist in integrating their voices effectively. Initiatives like the PREFER project highlight the feasibility of collaborative partnerships to address these challenges. The PREFER project integrates patient preferences into medical product decision-making. With collaboration from patient stakeholders, it develops recommendations for industry guidelines, regulatory authorities, and health technology assessment bodies. Through evidence-based methodologies and clinical case studies, PREFER identifies when and how patient preferences can inform drug development effectively, enhancing patient-centricity in healthcare decision-making. Strengthening relationships with patient advocacy groups is key to fostering personalized support and education. Establish multiple channels for patients to provide feedback and suggestions, allowing organizations to continuously improve their risk adjustment strategies based on patient insights.

Partner with Episource 

At Episource, we understand the importance of patient-centricity in risk adjustment. Our comprehensive suite of services is designed to help healthcare organizations streamline contact and improve patient satisfaction through innovative technology and risk adjustment solutions. 

Our Pre-Visit Review service and Concurrent Review service encompasses patient-care risk adjustment. 

Our Concurrent Review solution prioritizes patient-centric care by providing providers with timely feedback to enhance patient encounters and ensure accurate diagnosis documentation before claim submission. Through notifications of confirmed and suspected diagnoses, we empower providers to deliver personalized and thorough care tailored to each patient’s needs.

Similarly, our Pre-Visit Review solution underscores patient-centricity by proactively distilling year-over-year diagnoses and clinically-suspected conditions for clinicians to address ahead of patient visits. By streamlining compliance queries during live encounters, we ensure comprehensive evaluation of patient health conditions, enabling providers to deliver effective and personalized care.

The adoption of patient-centric approaches to risk adjustment offers several advantages for healthcare organizations, providers, payers, and most importantly, patients themselves. By placing the patient at the center of the care journey, organizations can achieve improved patient outcomes, reduced healthcare resource utilization, shorter hospital stays, and lower rates of readmission. Ultimately, patient-centric risk adjustment leads to better overall health outcomes and enhanced patient satisfaction.


  1. How can we improve patient centricity in benefit-risk assessments?. How Can We Improve Patient Centricity In Benefit-Risk Assessments. (n.d.). https://www.clinicalleader.com/doc/how-can-we-improve-patient-centricity-in-benefit-risk-assessments-0001
  2. Gupta, B. A. (2024, January 9). A guide for shifting to a patient-centric business model. GeBBS Healthcare Solutions. https://gebbs.com/blog/a-guide-for-shifting-to-a-patient-centric-business-model/