Enhancing Risk Recapture: A Smarter Approach with Azara DRVS

One of the standout features of Azara DRVS is its EHR Plug-in, which leverages SMART on FHIR APIs to seamlessly integrate critical patient data at the point of care. This innovative technology allows clinicians to access essential Azara insights such as open care gaps, risk adjustment factor gaps, open referrals, and care management plans directly within their EHR systems. Available for popular EHR platforms like athenaOne, NextGen, eClinicalWorks, and Epic, the Plug-in enhances workflow efficiency by reducing the need to navigate multiple systems while ensuring care teams have what they need at their fingertips.

For healthcare organizations focused on the transition to value-based care, the EHR Plug-in offers unique benefits for the capture of Risk Adjustment Factors (RAF). RAFs are the conditions and their level of severity that a patient presents, which provide health plans and government agencies an opportunity to predict future care needs and costs.

The factors that influence RAF are coded by providers during patient visits and affect the payments those providers receive from health plans to manage the care of these patients. While there are many RAF models, the CMS Hierarchical Condition Categories (HCC) is used by Medicare and is a key component of its value-based care shift.

To calculate a patient’s HCC score and conditions, DRVS utilizes a combination of charge-diagnoses from the EHR and claims from health plans (including CMS)—and it can do this for any patient regardless of their insurance status. Once the HCC RAF score is calculated on the prior year's data, it can then be compared to the results from this year’s data to determine which conditions have been recorded during a patient visit via ICD-10 codes, and how much of last year’s score has been recaptured. Any conditions that have not been recaptured this year are considered RAF gaps, which are presented to providers at the point of care via the EHR Plug-in.

For a simplified example with the HCC algorithm: if a 68-year-old female patient had a visit in 2023 where type 2 diabetes with diabetic polyneuropathy (ICD-10 code E11.42) was diagnosed, the HCC algorithm would assign a total RAF score to this patient of 0.625 (0.323 for their age and gender and 0.302 for diabetes with complications). If this same patient then has a visit in 2024 and is now diagnosed with diabetes mellitus without complications (ICD-10 code E11.9), the HCC algorithm would assign a RAF score to this patient of 0.428 (0.323 for their age and gender and 0.105 for diabetes without complications) resulting in a risk recapture rate of 68% (0.428/0.625).

While a 32% risk score gap does not directly translate to a 32% drop in reimbursement from CMS to care for this patient, this type of drop in risk scores across an entire patient population can represent significant lost revenue for care-teams, practices, and health systems. Making sure providers are aware of previously diagnosed conditions at the time of the patient’s visit is a way to ensure that risk is recaptured, and why Azara added RAF gaps to the EHR Plug-in.

After several years of deployment across hundreds of EHR instances, Azara recently analyzed the impact of this tool and how it impacted providers’ coding and risk recapture rates. This analysis was done by looking at the year-over-year risk recapture rate for over 500 health centers that have been using Azara DRVS for 2 or more years and then identifying those that implemented the EHR Plug-in more than 6 months ago. It was found that health centers utilizing the EHR Plug-in in 2024 saw a 1.9% improvement in their year-to-year risk recapture, compared to a 0.3% increase for health centers without the Plug-in. These results indicate that implementing the DRVS EHR Plug-in is associated with a 1.6% improvement in risk-recapture.

It was found that health centers utilizing the EHR Plug-in in 2024 saw a 1.9% improvement in their year-to-year risk recapture, compared to a 0.3% increase for health centers without the Plug-in. These results indicate that implementing the DRVS EHR Plug-in is associated with a 1.6% improvement in risk-recapture.

Peeling back the layers of data that made up this result adds some interesting nuance. Higher risk recapture improvement is seen in a wide range patient population sizes, EHRs vendors, and regions of the country, which seems to indicate that this Azara-effect can apply to a wide range of provider circumstances. Interestingly, it was found that organizations with lower risk recapture rates in 2023 were more likely to enable the EHR Plug-in, which may indicate that the improvement seen was part of a broader organizational shift in focus to the tools and workflows needed to succeed in value-based care. This doesn’t necessarily undermine the value of the Plug-in itself; it just reinforces the idea that new technologies need to be implemented as part of a broader strategy.

While there are many benefits to the DRVS EHR Plug-in, its measurable impact on risk recapture is impressive and speaks to its power for organizations adapting to changing payment models. By accurately representing patient complexity to health plans and enhancing reimbursement of patient visits, tools that assist with risk-recapture are essential for organizations in value-based care arrangements. As Azara continues to innovate and refine its products, we remain dedicated to making healthcare work smarter and simpler, while ensuring that our solutions evolve to meet the ever-changing needs of healthcare professionals and organizations. Stay tuned for more advancements as we strive to enhance patient care and operational efficiency.