4 Essential Risk Adjustment KPIs for Your First 90 Days

The first 90 days of implementing a risk adjustment program are critical to laying the foundation for long-term success. Whether your goal is optimizing HCC (Hierarchical Condition Category) coding, improving clinical documentation, or ensuring compliance, tracking the right Key Performance Indicators (KPIs) during this period is essential. These Risk Adjustment KPIs help measure progress, identify quick wins, and highlight improvement areas.

 

But why is it crucial to focus on KPIs during this initial phase? Let’s explore how tracking metrics can shape the success of your risk adjustment implementation and ensure your organization stays on the path to achieving its goals.

The Importance of Tracking Risk Adjustment KPIs Early

 

KPIs help establish a clear baseline for improvement, allowing organizations to measure progress and evaluate the program’s impact over time. By identifying metrics like HCC capture rates or coding accuracy, healthcare teams gain data-driven insights to prioritize efforts, focus on underperforming areas, and allocate resources effectively. This approach ensures that you can address early challenges systematically, avoiding wasted time and effort.

 

Monitoring progress is also critical to driving accountability and engagement across teams. Risk adjustment success depends on collaboration between clinicians, coders, and operational leaders. Tracking metrics like clinician engagement ensures that everyone is aligned and working toward shared goals. Celebrating early wins, such as improved coding practices or standardized workflows, can build momentum and morale. 

 

Simultaneously, monitoring compliance-related metrics mitigates risks, ensuring documentation meets regulatory standards and avoids potential audit pitfalls.

 

Additionally, Risk Adjustment KPIs provide a roadmap for long-term success by enabling scalability and stakeholder confidence. Metrics tracked in the first 90 days help refine processes that can be replicated across clinics and regions. Demonstrating measurable progress through KPIs reassures stakeholders that the program is delivering value and encourages ongoing support. 

 

In this way, these Risk Adjustment KPIs aren’t just short-term tools but the key to creating a sustainable, efficient, and impactful risk adjustment program.

 

Now that we’ve highlighted the importance of tracking KPIs early in the risk adjustment process let’s explore the specific metrics that can drive success.

 

4 Key Risk Adjustment KPIs to Track in Your First 90 Days

 

Let’s explore 4 essential KPIs for the first 90 days of risk adjustment implementation, giving you a clear roadmap to measure progress and optimize outcomes.

1. HCC Recapture Rate

Recapture Rate is the rate at which providers document (code) recurring (or chronic) HCC diagnoses annually. Compare your rates with industry benchmarks to identify outliers and gaps. A standard goal is an 85% recapture rate.

 

Why It Matters: Accurate and yearly documentation of HCCs ensures that reimbursement aligns with patient needs. Without it, chronic conditions may go unaccounted for, leading to gaps in care and inadequate funding. For clinicians, success in the HCC model means consistently monitoring and managing chronic conditions to prevent avoidable hospitalizations.

 

Quick Tip: Keep the active problem list updated to ensure chronic conditions are accurately tracked while preventing acute conditions from cluttering clinician focus. Implement clinical workflows that address chronic conditions during yearly visits, and use software like PDAP to identify chronic conditions that haven’t been documented yet this year. With PDAP, you can increase your Recapture rates by up to 95%.

 

2. Suspect review Rate

Are You Capturing the Final Diagnosis? When clinicians evaluate or treat a patient’s symptoms, it’s crucial to ensure the final condition is documented. Without proper follow-through, potential diagnoses may remain incomplete, impacting both patient care and risk adjustment. The Suspects Review Rate tracks how often providers confirm or dismiss flagged conditions, helping ensure comprehensive documentation and accurate risk scoring.

 

Why It Matters: In the HCC model, symptoms alone don’t contribute to reimbursement. So, clinicians must document the underlying condition causing the symptoms, whether they or a specialist are treating it. A high review rate ensures that these conditions are accurately captured, reducing missed diagnoses and improving the completeness of patient documentation.

Quick Tip: Use AI-powered suspecting tools to identify potential conditions that need follow-up automatically. These tools will highlight when results are returned and flag instances where symptoms might be under documented, helping ensure the underlying condition is captured correctly.

 

3. New Suspected Diagnoses

Uncover Undocumented & At-Risk Conditions. This metric tracks newly suspected conditions and additional diagnoses added to patient records—conditions that were either previously undocumented or flagged for provider review.

 

Why It Matters: Capturing these conditions ensures comprehensive risk adjustment and better patient care. Identifying new diagnoses prevents gaps in documentation, while reviewing suspected conditions enables early detection and intervention. By leveraging vital signs, lab results, and screening tests, clinicians can catch chronic conditions before they worsen, improving outcomes and risk score accuracy.

 

Quick Tip: Use AI-powered coding assistants and predictive analytics tools to surface potential missed diagnoses in real time. Implement diagnosis guidelines and screening protocols to prioritize critical suspects, reducing time spent on low-priority reviews.

 

4. Suspects Addressed 

You need software to help you monitor this KPI, but tracking potential conditions while they are being worked up avoids conditions being lost in referrals or pending testing. Not every suspected diagnosis turns into an actual condition, but suspected conditions need to be worked up, i.e., you can turn suspects into diagnoses (or rule them out). This KPI tracks how many have been reviewed and resolved.

 

Why It Matters: It ensures providers follow up on potential diagnoses and document HCCs compliantly, preventing missed codes. Addressing suspects promptly helps avoid overlooked diagnoses, ensuring accurate risk scores while maintaining proper documentation practices

 

Quick Tip: Leverage software to automate workflows that assign suspected conditions to the right provider, streamlining the review process and ensuring faster resolution.

 

How Technology Bridges the Gap: Introducing DoctusTech’s PDAP Dashboard

 

Tracking these KPIs manually is like navigating a maze without a map—time-consuming, frustrating, and prone to errors. That’s where technology comes in. With the right tools, clinicians can focus on patient care while ensuring accurate documentation, optimized risk scores, and maximized reimbursements. This is where a dashboard with all these metrics comes in handy—and DoctusTech has already built it for you.

 

Meet DoctusTech’s HCC Patient Diagnosis Assist Platform (PDAP)

 

PDAP is an HCC coding software with AI-powered features designed to streamline workflows, boost RAF accuracy, and enhance clinician engagement—all while ensuring compliance. But what makes it a game-changer?

 

• • A Smarter Way to Track KPIs – The PDAP Dashboard provides real-time visibility into all the critical metrics we just discussed—Suspect Review Rate, Recapture Rates, New Suspected & Hidden Diagnoses, and more. No more guesswork—just clear, actionable insights.

 

• • Less Time on Documentation, More Time for Patients – With AI-powered automation, PDAP saves clinicians up to 2.5 hours per week by streamlining chart reviews, surfacing the right diagnoses, and eliminating redundant workflows.

 

• • Real-Time Alerts for Compliance & Accuracy – PDAP ensures that no diagnosis falls through the cracks. It cross-references clinical data, flags non-compliant notes, and integrates seamlessly with 70+ EMRs, ensuring every recapture is timely and accurate.

 

• • Proven Results in Just 6 Months – Organizations using PDAP have seen a 92% Chronic HCC Recapture Rate, a 90% clinician engagement rate, and dramatically improved risk adjustment accuracy.

Turn KPIs into Action with PDAP

 

 

Instead of juggling spreadsheets and manual processes, let PDAP do the heavy lifting. With real-time insights and automated workflows, providers can seamlessly close documentation gaps, ensure RAF accuracy, and improve patient outcomes without extra administrative burden.

 

Final Thoughts: Building a Foundation for Long-Term Success

 

Implementing a risk adjustment program is a journey, but tracking the right KPIs during the first 90 days provides a roadmap for success. From coding accuracy and clinician engagement to compliance and financial impact, these metrics help identify challenges, validate strategies, and highlight areas needing optimization.

 

Remember, success lies in achieving KPIs and creating a culture of continuous improvement. By focusing on data-driven insights and fostering collaboration among clinicians, coders, and operational leaders, your organization can maximize the value of its risk adjustment program. Curious about how PDAP can transform your workflow? Let’s talk!