Risk Score Optimization

QMetrics staff have extensive experience optimizing member risk scores to ensure that payments received are appropriate for the unique care needs of your member population.

We can assist you with optimizing your retrospective and prospective member risk score improvement activities and their associated suspect lists to ensure the maximum ROI per chart and/or the greatest overall revenue improvement for:

  • Medicare Advantage (CMS-HCC)
  • Commercial Exchange (HHS-HCC)
  • Medicaid (CDPS, CDPS-Rx, and others) models.

We understand the unique barriers to care that your members may face in accessing health and can help you directly target those needs. Our Senior Health Economist has lectured across the country on the value of addressing Social Determinants of Health for the past 10 years – long before this term became a “buzzword” in health care.

We round out our risk score improvement assistance by expanding beyond the traditional closing of “Care Gaps”, to include the closure of “Data Gaps” so that you get credit for all of the care you are providing.

Contact us at: info@qmetrics.us for a complimentary consultation.