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HCC & RAF Analytics
Risk Adjustment · Diagnosis Attestation
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Medicare Advantage
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West Medical Center
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Value-Based Care
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Payor Incentive
Period
CY 2026 YTD
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CY 2026 YTD
Q1 2026
Q2 2026
CY 2025
Last 12 months
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
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
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
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Conditions
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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:
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Has Open Gaps
All Closed
Has Suspected
RAF:
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All
High (≥ 2.0)
Medium (1.0–1.99)
Low (< 1.0)
Program:
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All programs
Value-Based Care
Chronic Care Mgmt
Remote Pt. Monitoring
Not enrolled
Last Visit:
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Last 30 days
Last 90 days
Last 6 months
Last 12 months
Overdue (> 12 mo)
0
of
0
patients
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Provider
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Facility
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Cond
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Open
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RAF
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Gap $ ↓
Last Visit
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Care Coord
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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
Overview
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Patient Overview
Patient Detail
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