Risk adjustment

Capture what counts at the point of care

IMO Health simplifies clinical workflows by surfacing actionable insights from prior encounters, unstructured notes, and payer data directly within the problem list.

Missing HCCs put up to

0 %

of value-based revenue at risk.

Streamline your risk adjustment workflow to better document HCCs and diagnosis specificity.

Improve HCC capture

Notify clinicians of potentially missing chronic details, within clinical workflows, to minimize documentation rework.

Document with precision

Capture complex conditions with guided ICD-10-CM refinement tools to improve specificity and meet risk adjustment requirements.

Strengthen collaboration

Centralize care team and multi-payer insights on the problem list to improve care outcomes.

Leverage award-winning NLP

Uncover undocumented conditions in unstructured notes and close coding gaps in prior-year documentation to strengthen compliance and RADV audit readiness.

IMO Health improves diagnostic integrity by capturing greater specificity and surfacing risk adjustment insights to drive value-based care.

7% boost in RAF scores

Within six months of implementing IMO Core, Concord Hospital's cumulative RAF score exceeded the previous year's by 7% and improved diagnosis specificity by 33%.

“[Providers] are giving me the feedback, ‘I really didn’t realize I was under-coding my patients so much and that there was so much more detail that you could add to that diagnosis to really dial it down and paint a clear picture of the patient.’”

Even when accepting only 5% of HCC suggestions, a large midwestern hospital is on track to unlock $300k in Medicare Advantage reimbursements*

*Reimbursement projected over a one-month period

A 100+ physician group in northern Illinois increased RAF values by 24%, HCCs per patient by 16%, and grew annual risk bonuses by $1.9M with IMO Health.

FAQS

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How does IMO Health improve risk adjustment and surface relevant HCCs?

IMO Health improves risk adjustment by embedding relevant HCC insights directly into clinical workflows. Providers see these HCCs in the problem list before or during the visit, ensuring accurate diagnosis capture in real time. Our technology leverages prior encounters, unstructured EHR notes, and payer gap-in-care data to surface suspected or overlooked HCCs and chronic conditions. This ensures that full clinical intent is captured, supporting accurate RAF scores, compliance, and quality reporting across Medicare Advantage (CMS-HCCs), ACA Marketplace (HHS-HCC), Medicare Part D (RxHCC), and state-defined Medicaid (ACG, CDPS, CRG, DxCG).

What is the financial impact of IMO Health risk adjustment solutions?

IMO Health drives financial impact by improving diagnosis specificity with ICD-10-CM refinement tools and by surfacing actionable HCC insights directly in the problem list. Together, these capabilities strengthen risk scoring, quality of care, and audit readiness, while ensuring organizations are reimbursed appropriately for population complexity. By delivering a more complete patient picture, providers achieve RAF scores that align better with patient risk and support sustainable performance in value-based care programs. To illustrate this impact, IMO Health provides an HL7- powered dashboard to measure adoption and the financial impact from HCCs.

How does IMO Health support payer-provider collaboration?

IMO Health strengthens collaboration by surfacing payer-identified care gaps directly in the problem list, minimizing the need for manual reviews and follow-ups. Clinicians can accept or reject insights from multiple payer partners during the patient encounter, with responses tracked to reduce post-visit documentation rework and administrative burden. The result is better data that drives accurate risk scores, stronger quality metrics, and fair reimbursement.

Can IMO Health help organizations prepare for and respond to RADV audits from prior years?

IMO Health’s normalization technology helps health plans run retrospective internal mock RADV audits, ensuring charts align with current risk adjustment standards. It comprehensively maps structured and unstructured data to appropriate standard code sets, providing specific and accurate coding to optimize downstream data use. Our intuitive interface enables organizations to review, accept, and adjust matched data as needed, helping to identify and correct potentially miscoded diagnoses and data gaps. With these insights, teams can collaborate with providers to resolve discrepancies and ensure documentation accuracy, which is critical if selected for a RADV audit.

Ready to meet your VBC goals?

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