For ACOs: Make Risk Adjustment a Competitive Advantage

Value-based care is now the norm—not the exception. CMS continues to expand ACO participation and front-load primary-care investment (e.g., ACO Primary Care Flex in MSSP starting 2025–2029, and the Making Care Primary model launched July 1, 2024), reinforcing accurate documentation, coordinated care, and equity as core levers for performance. Centers for Medicare & Medicaid Services

Why Risk Adjustment Matters in ACOs

  • Payment fairness & benchmark accuracy. Risk adjustment normalizes for patient complexity so organizations caring for sicker populations aren’t penalized—and performance is compared on the care delivered, not the case mix. CMS models (e.g., CMS-HCC) use ICD-10 diagnosis codes to calculate risk scores. Centers for Medicare & Medicaid Services

  • Better population management. Accurate coding surfaces high-risk and rising-risk members for intervention and underpins financial forecasts and shared-savings strategies in MSSP and other CMMI models. Centers for Medicare & Medicaid Services

  • Consistent with current CMS models. CMS’ ongoing primary-care and ACO initiatives (e.g., ACO PC Flex, MCP) are designed to strengthen care teams and infrastructure—exactly where accurate, timely risk capture pays dividends. Centers for Medicare & Medicaid Services

Bottom line: Accurate, compliant documentation → reliable risk scores → fairer benchmarks, better care targeting, and stronger shared-savings potential.

How HDM Helps Your ACO Win

HDM Risk Adjustment Platform aligns frontline documentation with analytics and compliance—purpose-built for ACO operations.

  • AI-Powered Documentation Integrity
    NLP + rules detect missed or unspecified diagnoses in notes, discharges, and labs; align to ICD-10 → HCC; enforce MEAT criteria; and reduce audit exposure. (CMS publishes model codes and software for CMS-HCC, which our mappings follow.) Centers for Medicare & Medicaid Services

  • Provider Workflow Fit
    Point-of-care prompts, chart review queues, and feedback loops help clinicians document once, correctly—supporting MSSP quality reporting and downstream encounter integrity. Centers for Medicare & Medicaid Services

  • Submission & Reconciliation
    Clean EDI lifecycles (837/277/999) and encounter analytics ensure traceable, CMS-ready data—so your risk capture shows up in benchmarks and settlement. (Diagnosis-level files must contain eligible ICD-10 codes per CMS instructions.) Centers for Medicare & Medicaid Services

  • Population & Equity Analytics
    Flag high-risk cohorts, close care gaps, and track performance signals relevant to ACO programs—including initiatives supporting primary care and underserved communities.