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HCC & RAF Analytics

Risk Adjustment · Diagnosis Attestation
Refreshed 04:00 AM CT
Filters
Payor
All
Facility
All
Program
All
Period
CY 2026 YTD
No active cross-filters
Eligible Patients
12,486
▲ 4.2% vs LY
Chronic Conditions
41,902
▲ 6.8% vs LY
Closed Conditions
31,427
▲ 9.1% vs LY
Compliance Rate
75.0%
▲ 3.1 pts QoQ · Target 85%
RAF Capture Value
$8.42M
▲ $612K YTD · Avg RAF 1.84
Compliance Trend
Closed ÷ Total chronic conditions, monthly
85% target
JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC
Attestation Status
All chronic conditions, click slice to filter
75%Closed
Closed
31,427
75.0%
Addressed
3,812
9.1%
Disagreed
1,247
3.0%
Open
5,416
12.9%
Top HCC Categories
By condition count · click to filter
Diabetes
3,184
CHF
2,701
COPD
2,210
CKD Stage 3+
1,902
Maj. Depression
1,418
Cancer (active)
1,142
Top Providers · Compliance
Click to drill-through to facility
Dr. Patel, R.
94%
Dr. Nguyen, T.
91%
Dr. Williams, K.
88%
Dr. Garcia, M.
84%
Dr. O'Brien, S.
81%
Dr. Chen, A.
76%
RAF Score Distribution
Patients by score band · click to filter
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5+
Facilities In Scope
14
8 above 75% target
Paneled Providers
186
▲ 12 onboarded
Avg RAF / Patient
1.84
▲ 0.07 vs LY
Open Gap Value
$2.71M
▼ 8% MoM
Facilities — Performance Matrix
Click row to cross-filter providers · right-click to drill through
Facility Patients Conditions Closed Compliance ↓ Avg RAF Gap $
Providers
All facilities
Payor Mix · Compliance
Medicare Adv.
84%
Medicare
79%
Commercial
71%
Medicaid
66%
Patients In View
12,486
All facilities
Patients w/ Open Gaps
6,842
▲ 4.1% MoM
Avg RAF / Patient
1.84
▲ 0.07 vs LY
Total Open Gap $
$2.71M
Across cohort
High-Risk (RAF ≥ 2.0)
3,748
30% of cohort
Patient Cohort · CY 2026
Click a patient to drill through to detail · right-click for more options
Status: All
RAF: All
Program: All
Last Visit: All
0 of 0 patients
Patient Age/Sex Payor Provider Facility Cond Open RAF Gap $ ↓ Last Visit Care Coord AI
JN
Jodyne N. Pennycuick
PID 1213447729
F · 69 yrs Payor: Medicare Adv. Provider: Dr. Patel, R. Facility: West Medical Ctr Last Encounter: Mar 18, 2026 Care Coord: L. Martinez
2.14
Total RAF
$13.1k
Gap $
4 / 7
Closed
Active HCC Conditions
Click to view ICD-10 details & encounter history
HCC 158
Pressure ulcer of other site, stage 3
L89.893 · Skin · Chronic
1.069
$10.0k
Open
HCC 52
Alzheimer's disease, unspecified
G30.9 · Neurological · Chronic
0.346
$3.24k
Closed
HCC 111
COPD, unspecified
J44.9 · Respiratory · Chronic
0.335
$3.14k
Closed
HCC 85
Other heart failure
I50.89 · Cardiovascular · Chronic
0.331
$3.10k
Addressed
HCC 18
Diabetes type 2 with nephropathy
E11.21 · Endocrine · Chronic
0.250
$2.34k
Closed
Anxiety disorder, unspecified
F41.9 · Behavioral · Chronic (no HCC)
$0
Closed
HCC 22
Suspected: Morbid obesity (BMI 40+)
E66.01 · Endocrine · Suspected
0.210
$1.96k
Suspected
Risk Score · 6-Year Trend
2021 2022 2023 2024 2025 2026 peak 2.71
Encounter Timeline
Mar 18
Annual Wellness Visit
Dr. Patel · 4 conditions attested
Feb 02
Follow-up · CHF
Dr. Williams · 1 condition addressed
Dec 14
Wound care consult
RN Garcia · documented
Nov 02
Lab review
A1C · BMP · Lipid panel
JN
Jodyne N. Pennycuick PID 1213447729
F · 69 Provider: Dr. Patel, R. Facility: West Med Ctr
5Findings
+1.42Potential RAF
$13.3kPotential $
Analyzed Apr 24, 2026 · Run #142
AI Summary
This patient shows 5 potential documentation opportunities. Prior-year CHF (HCC 85) has not been recaptured in 2026 despite active diuretic therapy. Current metformin and gabapentin prescriptions without a coded diabetes diagnosis suggest an unreported or under-specified condition, supported by two A1C results at or above 6.9. Sustained BMI readings over 40 across four visits support a morbid obesity code. One external claim from an outside cardiology group references atrial fibrillation not present in the CHN problem list.
Generated overnight by the local model from precomputed pattern matches. No live AI is called by this page. Proposed findings require provider review before any chart change.
Suspected Findings · CY 2026
Click a finding to expand evidence and actions
Confidence: All
5 active · 0 disposed
Outside Sources
External claims & HIE, not in CHN chart
Atrial fibrillation I48.91 · HCC 96
Heartland Cardiology Assoc.Claim · Feb 2026
Peripheral vascular disease I73.9 · HCC 108
Regional HIE feedEncounter · Nov 2025
Osteoporosis w/ fracture hx M80.08 · HCC 169
St. Mary's Hospital dischargeInpatient · Sep 2025
Disposition History
Previously reviewed for this patient
Mar 02
Dismissed: Suspected hypothyroidism (E03.9)
Dr. Patel · Reviewed, labs within range
Jan 15
Added via ICE: Chronic kidney disease st. 3a (N18.31)
Dr. Patel · Confirmed at AWV, coded same day
Nov 20
Dismissed: Med-implied seizure disorder (G40.909)
Dr. Williams · Gabapentin is for neuropathy
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