Navigating the Shift: Deciphering the Significance of RAF Score v24 vs. v28 Comparison

The healthcare realm is on the cusp of a major transformation, transitioning from RAF Score v24 to v28 in the CMS HCC model. Grasping the nuances of these versions is crucial for healthcare entities seeking precise risk assessments and seamless transitions.

RAF Score v28: Redefining Risk Adjustment

Beyond a mere update, RAF Score v28 signifies a fundamental change in risk management for health plans. Expected to impact Medicare Advantage risk scores by 3% to 8%, this version brings consequential alterations affecting revenue, care planning, and strategic direction.

Transition Timeline: Decoding the Phased Evolution

The shift from v24 to v28 follows a meticulous timeline. In 2023, v24 holds a 67% weight, transitioning to v28 dominance at 67% in 2024 and reaching 100% in 2025.

Early Transition Benefits: Navigating the Changing Landscape

Early adoption is crucial for:

Accuracy and Compliance:

Ensuring precise risk assessment aligns with regulations, reducing compliance risks.

Strategic Planning:

Proactively planning for revenue decrease supports financial sustainability initiatives.

Operational Efficiency:

: A smooth transition minimizes disruptions, allowing focus on patient care and value-based partnerships.

Competitive Advantage:

Early adopters gain an advantage, adapting to new requirements and potentially outperforming competitors.

Patient Outcomes:

Early transition facilitates accurate risk assessment, improving care planning and health outcomes.

Initiating Transition:

Features of an Adaptive Analytics Tool

An adaptive analytics tool should provide

Comprehensive v28 Model Analysis:

Insights into the v28 model's impact for informed decision-making.

Seamless Transition:

User-friendly platforms for minimal disruption during the shift.Revenue Optimization: Tools maximizing revenue capture under the v28 model.

Proactive Risk Adjustment:

Technology for prospectively planned care programs based on precise member demographics.

Key Changes: Unveiling the Transformation from v24 to v28

Changes include:

Increased HCC Categories:

: Rising from 86 to 115, with renumbered categories.Elimination and Renumbering: Some categories removed, with renumbering.

Coding Structure Change:

v28 adopts ICD-10-CM codes, departing from ICD-9-CM.Impact on Diabetes Coding: Decreased values in v28, with some categories no longer mapping to a risk score.

Constraining HCCs:

v28 uses constraining, where related HCCs receive the same coefficients.

Understanding these changes is pivotal for healthcare stakeholders, ensuring compliance and strategic positioning in a rapidly evolving landscape. The ongoing comparison of RAF Score v24 and v28 is instrumental for payors and providers, fostering informed decision-making, precise risk assessments, and optimal patient outcomes. As the industry embraces this shift, strategic partners with adaptable analytics become paramount for successfully mastering the v28 model.