Predictive Risk Adjustment Factor (RAF)

Understanding and managing the unknown rising risk within member populations is the key to success in value-based organizations & contracts

Don't miss on your RAF Revenue

Get an early start to capture appropriate conditions for Risk Adjustment

Risk Adjustment Factor (RAF) Calculator

Find out how BaseHealth can find revenue you are missing and accelerate your claims using our RAF Calculator.

*RAF Calculator is only an estimate based on past customer results

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What is Predictive RAF?

BaseHealth’s Predictive RAF Analytics prospectively pinpoints RAF score adjustment opportunity and revenue potential in MA populations for the plan year, and suspectively identifies the actual members who should be targeted for diagnostics and therapeutic intervention.

Our comprehensive precision analytics platform bridges Big Data, population-level insights with Small Data, member-level interventional actions that will increase and accelerate RAF revenue, and in turn, improve clinical outcomes and deliver ROI.

Why is Predictive RAF important?

To be successful in Medicare Advantage (MA), it's essential to capture all of the revenue to which a plan is entitled based on the risk of enrolled MA populations. While CMS allows for adjustment to RAF score and payments, most MA plans and health systems bearing downside risk rely largely on retrospective capture of diagnosis, potentially missing out on revenue opportunities for high risk members with diagnosable conditions that would warrant RAF score adjustment.

Our Predictive RAF Analytics use state-of-the-art science and evidence-based methodologies to provide healthcare practitioners with clinical guidance for rising condition risks and help them to treat patients today based on what is likely to occur tomorrow. BaseHealth's analytics and clinical guidance proves for more proactive diagnosis and treatment for emerging conditions, and improves clinical outcomes, more accurate RAF scores and corrected revenue payments. Better anticipation of patient needs, along with proactive diagnosis and treatment plans, ultimately benefits member well-being in addition to driving favorable MA plan health system financial results.

How does Predictive RAF add value?

BaseHealth’s data shows that with early prediction and targeted intervention of Medicare Advantage members at high risk for intervenable chronic or acute conditions, or trauma with inaccurate RAF scores, will help MA plans and health systems avoid missed or incomplete diagnosis, as well as INCREASE and ACCELERATE REVENUE, therefore IMPROVING QUALITY OF CARE.

See how BaseHealth's Predictive Risk Adjustment Factor (RAF): A Case Study with an Integrated Health System revealed nearly $13 million in missed revenue, and $5 million in accelerated revenue within a Medicare Advantage Population of 25,000 (study conducted with Banner Health).

Strategic Last Mile Solutions

Hear what experts are saying!

"BaseHealth provides us with target revenue and timing benchmarks against which we can measure revenue cycle optimization. Their suspective analytics specifically identifies members with low RAF scores who are at high risk for conditions likely undiagnosed for which RAF score adjustment is appropriate."

Barrie Bradley, Ph.D. Senior Director, Clinical Performance Analytics
Banner Health

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