https://info.cotiviti.com/hubfs/Pre-Visit%20Prep%20Case%20Study_blog.webp
RISK ADJUSTMENT (PROVIDER)

Case Study: Improving risk capture with advanced pre-visit prep

Health systems should expect increasing pressure to improve risk adjustment accuracy and code capture while reducing administrative burden. Many organizations still rely on manual processes, incomplete or fragmented data, and workflows that make it difficult to surface all relevant clinical insights to a clinician before a patient visit. As a result, opportunities to assess and document important conditions are often missed, impacting patient care quality and financial performance.

One leading regional health system transformed its approach by moving from retrospective, manual workflows to a proactive, data-driven model. By leveraging an advanced pre-visit preparation platform, the organization enabled clinicians to access prioritized, clinically supported insights at the point of care, improving both efficiency and outcomes.

Read our new case study to learn how the health system:

  • Replaced manual diagnosis gap identification with a proactive, data-driven pre-visit strategy
  • Surfaced clinically indicated suspected conditions across their relevant, risk adjustable patient population
  • Improved provider engagement and streamlined workflows for point-of-care decision-making
  • Overcame data fragmentation and interoperability challenges across multiple systems
  • Achieved measurable gains in risk capture and documentation accuracy through advanced analytics


This success reflects a larger shift happening across healthcare as organizations embrace a connected, intelligence-driven approach, closing the information gap between payers and providers and bringing actionable insights directly into clinical workflows.

Read the full case study to see how this transformation delivered meaningful results, including stronger risk capture performance, improved documentation accuracy, and reduced reliance on retrospective review processes, positioning the organization as a regional leader in value-based care.

WRITTEN BY

Betty Stump, MHA, RHIT, CPC, CDIP
Betty serves as a senior solution consultant for Edifecs, a Cotiviti business, focused on supporting customers seeking to incorporate technology solutions to solve the complexity of risk adjustment capture and reporting. Bringing more than 40 years’ experience in healthcare to her role, she holds numerous credentials in health information, coding, and clinical documentation integrity, and has a master’s degree in healthcare administration.

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