Successful Risk Adjustment Improves Gap Closures: A Real-World Success Story from a Large Regional Health Plan


Risk adjustment can be an effective solution for identifying potential gaps in care among beneficiaries. But payers face numerous challenges navigating the risk adjustment landscape.

Learn how one regional health plan’s goals were achieved or exceeded year upon year with steadily improved completion of provider alerts through an ongoing partnership with Veradigm, a pairing for success.

This paper provides insight into how Veradigm helped one large regional health insurer overcome numerous challenges to strengthen their risk adjustment program, investing together in people and processes, as well as product solutions, to achieve measurable success, including:

  • Closure of appropriate risk adjustment gaps
  • Clinician feedback on conditions not applying to members
  • Achievement of more accurate and complete risk scores, allowing them to deploy the right interventions, with the right providers, at the right times

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