A more proactive approach to risk adjustment

As regulatory scrutiny increases, health plans are looking beyond retrospective review alone and investing in more proactive approaches that strengthen risk adjustment accuracy earlier in the care journey.

In this case study, learn how a large regional insurer partnered with Optum to move risk intervention earlier in the care cycle through proactive gap closure, provider workflow integration and data-driven support.

Discover how Optum worked with a health plan to help build a more scalable, point-of-care model by:

Shifting risk adjustment efforts upstream to help improve coding accuracy and documentation before submission
Embedding risk insights into provider workflows through point-of-care gap closure and EHR-connected tools
Tailoring support strategies across different provider arrangements
Strengthening governance, compliance and RADV risk mitigation efforts
Leveraging automation and AI to help prioritize opportunities and manage coding volume more efficiently