Risk that reflects reality.
In value-based contracts, missed conditions and open care gaps quietly cost money, and audits punish coding the chart cannot support. Value-Based Care & Risk Adjustment reads every encounter and turns it into defensible risk and quality evidence. Suspected conditions are surfaced from notes, labs, problem lists, and feeds, then held until the documentation supports them. Our certified coders review every code against MEAT (monitor, evaluate, assess, treat), care gaps are closed with provider-friendly prompts, and each submitted code keeps the sentence, page, and date of service behind it. Built for ACOs, MSOs, and at-risk medical groups.
Improve quality outcomes and strengthen value-based performance.
In value-based contracts, missed conditions and unclosed gaps quietly cost money. Audits punish unsupported coding.
Suspected conditions surfaced with MEAT-supported documentation, gaps closed with provider workflows, and every code kept defensible.
Inside Value-Based Care & Risk Adjustment
Every capability below exists because a practice asked for it. Nothing here is a roadmap item.
RAF & HCC review
Hierarchy pruning and interaction scoring under CMS-HCC V24 and V28, matched to the right model year for each date of service.
Suspected condition capture
Conditions suggested by labs, medications, and history surfaced with the evidence attached, and held until the chart can prove them.
Specificity and MEAT validation
Unspecified codes upgraded only when the chart supports stage, laterality, or etiology. Every code scored against MEAT before it counts.
Care gaps and quality measures
HEDIS and Stars gaps tracked beside the risk picture, with the closing order or task in the same row.
Provider documentation feedback
Short, specific prompts in pre-visit prep or at the point of care: the sentence that is missing, not a generic query.
RADV-ready audit trail
Billability, hierarchy, and coding-risk checks on every submission, with a defensible packet per code for any sampled member.
Audit-ready the moment it is coded.
Every submitted HCC links to a dated, signed note with MEAT met, exportable as a defensible packet for any sampled member.
A1c 9.2%, up from 8.1% in December
Captured from this sentence, note p.1, DOS 03/14/2025. Added to the defense file.
- MA1c trend reviewed
- ERetinal screen ordered
- ADiabetes w/ CKD, stable
- TMetformin dose adjusted
- Diabetes w/ CKDE11.22
- Chronic diastolic HFI50.32
- CKD stage 3aN18.31
Every code traced to source · RADV-ready packet on file
Sentence-level evidence
Every code links to the exact words in the note that support it
MEAT validation
Monitoring, evaluation, assessment, treatment, checked before submission
Signed & attested
Dated, signed notes with provider credentials verified
One-click RADV packet
A defensible export for any sampled member, assembled from the chart
Illustrative example · not real patient data
From the schedule to the signed record
Surface
HCC gaps, suspected conditions, and quality measure misses identified from the chart and your feeds.
Validate
Certified coders review every recommendation against MEAT criteria and the clinical evidence.
Engage
Provider-friendly documentation prompts in pre-visit prep or at the point of care.
Track
Gap closure, RAF impact, and quality performance tracked against your contract targets.
Facts, not promises.
These are properties of how Value-Based Care & Risk Adjustment is built, not projected savings. Results in your practice depend on your payers, your panel, and your documentation.
Monitor, evaluate, assess, and treat checked before submission
Matched to the right payment year per date of service
Sentence, page, date of service, and signature ready for RADV
The anatomy of a value-based signal.
Every suspected condition and open gap arrives with the evidence to act on it, and the trail to defend it later.
Surfaced from the chart
Notes, labs, problem lists, and feeds read continuously, so conditions do not wait for the annual visit.
Audit-ready by default
Every documented code carries its MEAT trail: the sentence, page, and date of service behind it.
Only what is provable
Suspected codes wait until the chart supports them. What reaches your RAF is what an auditor can verify.
Quality in the same view
HEDIS and Stars gaps tracked beside the risk picture, with the closing order in the same row.
Human review at every gate
Certified coders approve every code through QA and senior review before anything is submitted.
Revenue and care, measured the same way
Risk, quality, and contract economics run on one set of facts, so nothing drifts between them.
A good fit when…
- ACOs, MSOs, and medical groups in Medicare Advantage or shared-savings contracts
- Organizations preparing for, or recovering from, a RADV or payer risk adjustment audit
- Groups whose RAF does not match how sick their panel actually is
- Teams tracking quality gaps in one tool and risk in another
The questions leaders ask first.
Don’t see yours? Bring it to a working session and we’ll walk it through with your data.
We ingest your roster and payer attribution files, reconcile them against encounters, and count every life once, so the panel you see is the panel you are measured on.
See Value-Based Care & Risk Adjustment on your own workflow.
Tell us what your organization is fighting (open care gaps, documentation, denials, coverage) and we will walk you through the part of the platform that closes it.