Our Risk Assessment feature leverages patient chart data and an industry standardized measure to empower providers with a snapshot of patient’s health risk at the point of care. It is a close approximation of the Hierarchical Condition Category (HCC) model used by the CMS to evaluate how sick patients are and conduct Risk Adjustment Factors.
- Display a calculated patient risk score
- Break down risk by diagnosis and ICD-10 code
- Highlight high risk problems not addressed in the current calendar year
Providers participating in value based care programs (CPC+, HMSA) and/or providing care to Medicare Advantage patients also benefit from a new report focused on patients 65 and above. It shows real time how accurately your expected reimbursements will reflect your patient panel by:
- Summarizing the severity of your patient panel
- Identifying eligible patients
- Surfacing outstanding chronic care items by patient
This article provides an overview of the feature and a step by step guide of how to use it. You can reference it at any time to understand how to:
- Enable or disable Risk Assessment in Settings
- Interpret Elation's risk score
- Locate risk score in the Patient Chart
- Address outstanding care items in the Problem List
- Inform documentation with Risk Assessment
- Gain visibility into your expected CMS reimbursements
Choose if Risk Assessment information displays in Patient Charts or in Reports by:
- Opening Elation Settings
- Selecting Clinical Care Measures
- Scrolling to the bottom and turning on or off the “Risk Assessment” toggle
The Elation Risk Assessment is a close approximation of the Hierarchical Condition Category (HCC) model. It is used by the CMS to evaluate each patient's health status and conduct Risk Adjustment Factors. This information then adjusts reimbursements to plans based on the risk of the beneficiaries they enroll, instead of calculating an average amount of Medicare/Medicare advantage beneficiaries.
Factors that affect the score include:
- Patient demographics (age and gender)
- Chronic condition diagnoses, based on ICD-10 codes selected in the patient's problem list
- Certain comorbidities
- A normalization factor to adjust beneficiaries' risk scores so that the average risk score is 1.0 in years.
- A coding intensity factor which adjusts for the difference between MA and FFS coding
- Adjustments for if the patient is institutionalized or in the community
Risk Assessment is scored from 0 (lowest possible risk), where 1.0 is the average score for Medicare beneficiaries.
A patient's risk score appears underneath their photo in the upper lefthand corner of the chart. Ir provides a snapshot of how severe the patient's chronic conditions are.
As a reminder, Risk Assessment is scored from 0 (lowest possible risk), where 1.0 is the average score for Medicare beneficiaries.
Click on the risk score and a pop up window appears with comprehensive details of the score's calculation, as well as the option to specify the patient's living situation.
The date will be removed once the chronic condition has been documented within Elation during the calendar year.
CMS requires that each condition be addressed at least once in a calendar year in order to be eligible for reimbursement.
The problem selection window includes a new Risk column that shows the risk factor related to specific ICD-10 codes. You can use this information to determine the correct code to adequately represent the complexity and severity of the patient's problem.
Our Risk Assessment recapture report reflects the actual severity of your patient panel for patients 65 or older and identifies those who have not yet had their chronic conditions addressed in the current calendar year. CMS recalculates and reimburses patient risk every calendar year, and only accounts for problems addressed in claims during that time. This report is a quick way to see what percentage of patients are fully accounted for (meet criteria).
To access the Risk Assessment recapture report:
- Open Reports in the menu bar
- Click on Clinical Quality Measures
- Select Risk Assessment
You can filter the information by provider (for patients of) and determine the measurement period (annual or specified 12 month period).
The denominator (Total Eligible) counts the patients 65 or older who have a weighted risk factor in the problem list during the measurement period. The numerator (Meets Criteria) counts all patients who have all of those weight risk diagnoses appear in claims during the measurement period.
Click on "View List" at the right of the numbers to see a list of patients that do or do not meet criteria to inform your outreach and upcoming care plans.