For organizations managing risk-based contracts, risk adjustment factor (RAF) gap closure is both a reporting challenge and an operational imperative. The scale of the opportunity is significant: CMS estimated that the Medicare Advantage risk-score trend would account for more than $13 billion in additional plan payments in 2027, influenced in part by diagnosis coding patterns.
Success depends on more than identifying RAF opportunities. It relies on creating processes providers will actually use. While many teams can identify open RAF opportunities, the challenge is whether clinicians efficiently address those opportunities during the visit while documenting the diagnosis that most accurately reflects the patient’s current condition.
Many RAF workflows still depend on separate reports, registries, or retrospective outreach that require providers to leave their normal clinical workflow. The combination of the new Azara EHR Plug-In RAF Gap Actions, diagnosis writebacks, and Related RAF Diagnosis Lookup helps close the gap between analytics and execution by embedding RAF workflows directly into the point of care.
From Identification to Action: RAF Gap Actions and Diagnosis Writebacks
RAF gaps occur when a patient’s actual RAF score differs from the score they could have if all relevant chronic conditions were accurately documented and coded in the current year. When eligible conditions are not recaptured, those gaps can affect care quality metrics and reimbursement.
Available across supported EHR platforms, the Azara EHR Plug-In embeds population health insights directly within the clinical workflow, allowing providers to address care gaps, RAF opportunities, quality measures, and documentation recommendations without leaving the patient chart.
RAF Gap Actions now enable providers to dismiss a gap when a diagnosis no longer applies, defer a gap when additional follow-up is needed, or add a diagnosis directly to the EHR through diagnosis writebacks. This is where organizations can move from identifying RAF opportunities to helping providers address them in real time.
By incorporating these capabilities into existing care delivery processes, organizations can scale RAF recapture efforts without adding administrative burden. One organization putting these principles into practice is AccelHealth, a Community Health Center within the Texas Association of Community Health Centers, whose pilot demonstrates how integrating RAF workflows into clinical workflows can drive meaningful results.
AccelHealth's RAF Diagnosis Writeback Pilot
AccelHealth partnered with Azara Healthcare to pilot RAF gap writebacks in the EHR Plug-In via eClinical Works, with the goal of preparing the workflow for production and increasing RAF gap recapture rates. The rollout focused on practical adoption: educating providers on Risk Adjustment, training pilot clinicians on the Plug-In, monitoring results via DRVS reports, and expanding the process to additional clinicians.
The results were meaningful: RAF gap recapture increased 7% after one month with four providers using the workflow and later increased to 21% after broader provider implementation. AccelHealth also noted that after a larger scale rollout, providers better understood the importance of RAF recapture in value-based care contracts.
Just as important as the numbers was the provider feedback. Ashley Hall, LVN, Infection Prevention and Quality Nurse who helped organize rollout, training, and adoption at AccelHealth, described the value of viewing open RAF gaps and seeing diagnoses added from Azara’s Plug-In appear directly in the EHR:
“Having the writeback feature available has not only increased our RAF gap recapture rate, but it has also made it easier for me to have a reference point when working on RAF gap data for different payers.”
That feedback highlights the importance of diagnosis writebacks: reducing administrative effort, surfacing actionable insights at the point-of-care, simplifying RAF gap resolution during the visit, and eliminating the need to manually search lengthy problem lists. The value behind integrating the Plug-In workflow and RAF Gap Actions is not just in the actions providers can take, but also the focus and visibility it brings to Risk Adjustment Factor Coding in general.
The Next Step: Related RAF Diagnosis Lookup
Diagnosis writebacks solve a major challenge in the care delivery process, but they also raise an important clinical question: What if last year's documented condition is not the most accurate representation of the patient's health status today?
AccelHealth's experience demonstrates the value of reducing friction in RAF workflows. Once organizations make RAF opportunities easier to address, the next challenge becomes ensuring providers select the diagnosis that most accurately reflects the patient's current condition.
The Azara EHR Plug-In’s newest enhancement, Related RAF Diagnosis Lookup, builds on diagnosis writebacks by helping providers choose the diagnosis that best reflects the patient’s current condition, not just the diagnosis documented last year. The ROI is not simply access to more codes, it is more accurate and clinically-specific documentation that supports more complete capture of patient complexity, stronger RAF documentation, and more appropriate reimbursement.
This is especially valuable in common clinical scenarios:
- Specifying an unspecified diagnosis: A previously documented unspecified code can be replaced with a more specific diagnosis, when clinically appropriate.
- Patient condition improved: A patient’s condition may improve, requiring a related diagnosis that reflects lower severity.
- Patient condition worsened: A patient’s condition may worsen, requiring a related diagnosis that reflects higher severity.
In each scenario, the Plug-In helps providers select the diagnosis that most accurately reflects the patient's current condition.
Together, RAF Gap Actions, diagnosis writebacks, and Related RAF Diagnosis Lookup support both sides of RAF recapture, making it easier to act on opportunities while helping ensure documentation accurately reflects the patient’s current condition.
Streamlined Coding. Better Specificity. Stronger RAF Documentation.
The most successful RAF programs don't simply identify opportunities; they create scalable processes that enable providers to address them accurately and efficiently. By embedding RAF workflows directly into the EHR and helping clinicians select the most appropriate diagnosis, the Azara EHR Plug-In helps organizations scale recapture efforts while supporting more accurate representation of patient complexity across their value-based care programs.
The ROI is realized after a gap is surfaced: providers can address opportunities more efficiently and organizations gain documentation that better reflects patient complexity. By embedding RAF workflows directly into clinical workflows through tools like the Azara EHR Plug-In, organizations can move beyond retrospective reporting and create a more efficient, actionable approach to value-based care.
To learn more about Azara’s EHR Plug-In, RAF Gap Actions, diagnosis writebacks, and enhanced Related RAF Diagnosis Lookup attend our live webinar featuring Ashley Hall of AccelHealth and Rachel Hutcherson of Azara Healthcare on August 27th at 2PM ET. > Register Here
Ready to get started? Contact your Azara Client Success Manager, reach out to Azara Support at support@azarahealthcare.com.