As the healthcare industry adapts to rapid regulatory shifts, financial pressures, and evolving provider networks, health plans must optimize their approach to clinical data retrieval for risk adjustment and quality gap closure to remain efficient and compliant.
Here, we explore five best practices to enhance retrieval success, improve outcomes, foster collaboration, and enhance value—without increasing provider burden or placing strain on internal teams.
Build strong foundations
A successful retrieval program begins with a solid foundation. By investing in expert-driven processes that streamline operations, health plans can optimize key metrics, including time-to-retrieval and enhanced accuracy and completeness of clinical data. Consider these strategies:
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Leverage data across programs: Where appropriate, reuse retrieved charts across risk adjustment and quality programs, maximizing the value of each chart and reducing the need for multiple provider requests.
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Optimize requests: Reduce administrative burden by strategically grouping requests. By consolidating outreach by location, use case, and retrieval modality, retrieval partners can achieve significant efficiency gains for both providers and payers.
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Diversify channel strategy: While the shift to digital data gathering is critical, it’s equally important to maintain traditional communication channels. Flexible outreach strategies allow for the ability to work around gaps and meet providers where they are, ultimately driving higher retrieval rates.
Practice proactive, year-round improvement
Continuous improvement and proactive application of management throughout the measurement year is essential to retrieval and quality gap closure. Here are three ways teams can improve internal processes throughout the year:
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Conduct post-season reviews: After each HEDIS® season, review recent retrieval activities to identify what worked and what didn’t. Analyze data for gaps—such as missing provider contact information—and use these insights to inform future strategies.
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Start early: Initiate retrieval activities at the beginning of the measurement year. Early action allows for better planning, more effective gap closure, and the ability to leverage technology such as EMR integration and automated retrieval tools.
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Set up a monitoring framework: Set up a routine of team debriefs and feedback analysis to promptly identify delays and opportunities to improve processes.
Strengthen provider relationships
Strong provider relationships are at the heart of successful retrieval programs. Plans can help optimize engagement with these methods:
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Invest in provider feedback and engagement: Sharing retrieval outcomes and listening to provider input on request volume, timing, and format helps foster transparency and trust, encouraging providers to collaborate and support future retrieval efforts.
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Prioritize outreach to high-volume provider sites: This is especially important for sites that are challenging to engage during peak seasons.
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Provide a range of options: Include traditional and digital channels to accommodate different preferences and improve collaboration.
Improve collaboration across departments
Fostering internal engagement is equally as important as ensuring steady communication with external providers as siloed teams can lead to inefficiencies, missed opportunities, and reduced savings. Collaboration within teams is crucial for ongoing improvement. These approaches can support internal engagement:
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Centralize communication: Streamline processes by centralizing communication and distributing tasks across departments. This reduces administrative workload and enhances productivity.
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Implement continuous feedback: Regularly debrief with teams, analyze delays, and develop strategies to optimize results.
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Foster teamwork: Establish regular meetings to identify and resolve issues collaboratively. Leverage the expertise within your organization to drive innovation and continuous improvement.
Monitor KPIs to drive incremental gains
Maximizing clinical data retrieval success requires health plans to adopt collaborative strategies. Monitor KPIs and use analytics to track program performance and inform decision-making. Regularly review key performance targets and adjust strategies as needed.
Embrace trial and error while recognizing there is no one-size-fits-all solution. Encourage teams to experiment, learn from outcomes, and iterate on strategies to achieve sustainable success.
Proactive planning and early action are essential to improve the efficiency and effectiveness of risk and quality retrieval. Prioritizing strong provider relationships, internal engagement, and continuous improvement can boost clinical data retrieval and minimize provider burden. By investing in foundational best practices and embracing both digital and traditional communication channels, stakeholders can enhance value. Now is the time for healthcare organizations to lay the groundwork for sustainable, measurable success in 2026.
Webinar series: 2026 Risk Adjustment Essentials
Stay on top of the latest risk adjustment trends and insights with Cotiviti’s Risk Adjustment Essentials webinar series beginning March 3, 2026. Attend our first webinar as we:
- Break down key updates from the 2027 CMS Advance Notice
- Focus on early-year risk adjustment priorities
- Offer proven strategies for payers and providers
This article was co-authored by Senior Quality Director Taylor Henry, who drives performance in quality improvement, Stars programs, and medical record retrieval and abstraction for Cotiviti’s clients, specializing in aligning teams and processes to support health plans in achieving their strategic goals. With a commitment to improving performance and maintaining high standards, Taylor leads initiatives that drive operational excellence and promote positive outcomes.
