Featured Case Study
the organization
A multispecialty practice captures $504K in two months.
South Bend Clinic moves deeper into value-based care, but its RAF scores don’t reflect the true complexity of its patient population. With one HCC coder, the team increases average RAF scores by 34% through fully automated review.
RESULTS
Proof in practice.
- 34% increase in average RAF score.
- $504K additional value captured in less than two months.
- 100% automated HCC review with pre-claim HCC encounter review
“The value of Aptarro software is unprecedented, in fact, it’s a necessity for any organization with risk-based contracts.”
A multispecialty practice with more at stake.
Striving for value-based care.
With a commitment to aggressively move into value-based care, South Bend hoped to improve patient care while reducing costs. However, in order to take on more risk-based contracts, a scalable and cost-effective approach was essential to profitability.
They knew the key to financial success in value-based contracts was accurate RAF scores. They had already made major investments in a population health management solution and worked to build an analytics infrastructure for case managers, care coordinators, and providers with the goal to provide comprehensive preventative care, fill gaps in patient’s care, and manage chronic disease.
While South Bend made great strides on clinical initiatives, they realized there was a missing piece: their RAF scores did not accurately match up to their patient population. Their patients were sicker than their RAF scores indicated.
“The increase in revenue, required zero process changes to our clinical operations and optimized our coder’s productivity. Within 30 days we were up and running. On day one we saw immediate value by capturing missed RAF revenue. The increase in revenue required zero process changes to our clinical operations and optimized our coder’s productivity. Any value-based care organization should use Aptarro, it pays for itself ten-fold.”
“In a single week we saw an additional $100K+ in otherwise missing RAF value by using the Aptarro’s HCC Coding Engine. With Aptarro’s HCC Coding Engine, we were
easily able to scale up with value-based contracts. The value of the Aptarro software is unprecedented; in fact, it’s a necessity for any organization with risk based contracts.’’
Allowing the team to focus on high-value encounters only.
The South Bend Clinic hired a single HCC coder to concurrently review value-based encounters. They leveraged their coder and HCC Coding to improve RAF scores through increased HCC capture/re-capture rates. With automated review, 100% of their HCC encounters were audited pre-claim to ensure the most accurate HCC data was captured and submitted. By flagging HCC coding gaps, the coder focused solely on high-value encounters needing extra attention.
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