Unlike previous value-based care programs, LEAD establishes a long-term benchmark intended to support performance over a 10-year period. Organizations have a limited window to ensure patient complexity is accurately represented before entering the model.
Gather all external and internal documentation for patients
Gather and integrate documentation from all available sources, including specialist notes, hospital records, discharge summaries, and health information exchanges. Risk adjustment accuracy depends on seeing the full patient story.
Operationalize a strong recapture workflow
Identify previously reported conditions that require recapture and establish a process to review them throughout the year. Recapture should be a continuous workflow, not a year-end exercise, helping ensure chronic conditions are accurately reflected and supported by current documentation.
Build an Audit-Ready Risk Adjustment Program
Establish a proactive audit protection strategy that links every reported condition to the strongest available supporting evidence in the medical record. As scrutiny of risk adjustment continues to increase, organizations should prioritize documentation integrity alongside RAF accuracy.
Enable Risk Adjustment at the Point of Care
Implement a pre-visit planning process that identifies suspected conditions and care gaps before patient encounters. Delivering actionable insights to clinicians ahead of visits creates opportunities to address risk adjustment accurately and efficiently during the encounter itself.
The opportunity to influence your starting position in the LEAD Model is closing.
Need help identifying RAF gaps before the LEAD Model begins? Get in touch!