The key to accurate risk adjustment? Stronger clinical engagement.

Clinical engagement is the cornerstone of success in value-based care platforms. When payers and providers work together, they ensure alignment between clinical care delivery and risk adjustment strategies. Actively involving clinical voices in the entire risk continuum—from prospective to retrospective risk adjustment—improves coding accuracy, financial predictability, and patient outcomes.
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The power of engaged clinicians

Clinicians play a critical role in the success of value-based care by ensuring accurate documentation and, most importantly, proactively closing care gaps. By involving providers more actively in retrospective reviews, for example, payers can close documentation gaps and increase coding accuracy.  

With more accurate documentation, clinicians gain insights into how care delivery impacts reimbursement and patient outcomes, motivating them to prioritize accurate and complete records in future encounters. This creates a feedback loop that strengthens risk adjustment efforts and powers quality improvement.  

A collaborative approach to risk adjustment not only enhances financial outcomes and predictability— ensuring resources are directed to the highest need patients. It can power substantial improvements to patient care. Engaged clinicians are better equipped to identify high-risk patients early when presented with clinical insights to support gap closure and risk adjustment. When they have access to comprehensive clinical data and can better pinpoint patient care gaps, providers can optimize their interventions to drive measurable improvements in outcomes—well before retrospective risk deadlines.
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Four best practices for clinical collaboration

Despite the urgent need to foster clinical engagement, both providers and payers are dealing with increasing levels of administrative burden related to care documentation, clinical coding, data management, and technology integration. Here are four ways payers can effectively engage clinicians to ensure success in risk adjustment.

1. Surface clinical insights at the point of care.
‍Offering clinical insights and access to supporting evidence directly at the point of care is one of the most effective ways to engage clinicians in risk adjustment. Clinicians should be able to view easily digestible data with minimal clicks and directly from the EHR, making their workflows as simple as possible. This empowers them to make more informed treatment decisions, close care gaps, and accurately document patient conditions.

2. Use collaboration-friendly language.
Clinical collaboration requires direct lines of communication between payers and provider groups—communication free of technical or risk adjustment jargon. The impact on clinical workflows and patient outcomes has to be clearly articulated in any and all risk adjustment-related communication. When possible, demonstrate the time-savings and reduction in administrative burden as well.

3. Showcase the results.
To help improve clinical engagement and even create clinical champions for successful risk adjustment, provide transparent access to data and results. Highly visual dashboards, downloadable reports, and other analyses should be easily and frequently shared to showcase coding accuracy and improvement in patient outcomes. This data can drive performance improvement and further increase clinician buy-in.

4. Foster trust in technology.
Forty-one percent of physicians are both excited and concerned about using artificial intelligence (AI) in clinical care. Some clinicians worry it may reduce human interaction and threaten data privacy.

To help clinicians become more engaged in risk adjustment, start by involving them in the implementation of AI-powered technology systems used to power risk adjustment programs. Payers can shed light on the technology’s functionality, encouraging its use toward the achievement of value-based care goals.  

Furthermore, providing access to a wider range of patient data—and enabling access to that data in point-of-care workflows—makes it easier for clinicians to quickly close care gaps and identify their highest risk patients. It helps them target quality improvement initiatives and may be the most important way to engage clinicians in risk adjustment processes.

What to look for in collaboration-friendly technology

With advances in AI in healthcare, technology has the power to enhance clinical engagement. It can streamline key risk adjustment processes, provide invaluable access to patient data, and power retrospective, concurrent, and prospective risk adjustment programs.
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Increasing efficiency and productivity

By increasing risk adjustment efficiency and coder productivity, AI-powered technology can free up coder time, leaving more time for proactive quality improvement efforts.

• For example, accelerating medical record retrieval can produce incredible time-savings and reduce provider abrasion. AI-powered technology can quickly extract clinical evidence and even transform both structured and unstructured data into clear, holistic views of patient data.  

• Powering clinical review with AI can further support risk adjustment collaboration. Advances in AI have yielded fast and highly accurate clinical insights, enabling technology to support both coding teams with diagnosis detection and providers with clinical predictions.

• Dynamic validation further increases risk adjustment efficiency, adapting in real time to reduce redundant tasks for coders. Delivering transparent reporting for performance improvement  

Key to sustaining clinical engagement is ensuring that AI-generated clinical insights are transparent and backed by evidence. Technology that helps payers and clinical teams gain a full view of patient care and end-to-end risk adjustment workflows—complete with visual dashboards, downloadable reports, and customizable fields—encourages data-sharing and collaboration.

Offering an intuitive user experience

To foster clinical engagement, risk adjustment teams need technical features that make collaboration as simple and seamless as possible. Features that improve the user experience overall like dual-screen support, bulk actions, and dark mode ease the cognitive burden for users and encourage the use of technology. Furthermore, collaborative tools like inline notations, customizable markups, and history tracking make it easier for teams to work together and provide transparency into risk adjustment activities.
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How advanced risk adjustment technology can power clinical engagement

Powerful technology like Reveleer’s healthcare Risk Adjustment Solution and clinical intelligence can power payer-clinician collaboration for highly effective risk adjustment. AI-powered tools, lightning-speed processing, and an impeccable user experience modernize risk adjustment programs and foster clinical engagement, making risk programs faster, more accurate, and more effective than before.

Interested in enhancing clinical engagement for more effective retrospective risk adjustment?  Schedule a demo of Reveleer’s Risk Adjustment Solution.