The South Bend Clinic (SBC) made a commitment to aggressively move into value-based care to improve patient care while reducing costs. However, in order to take on more risk-based contracts, a scalable and cost-effective approach to ensure profitability was a necessity.
SBC knew the key to their financial success in value-based contracts was accurate RAF scores.
They had already made major investments in a population health management solution and
worked to build an analytics infrastructure for case managers, care coordinators, and providers
with the goal to provide comprehensive preventative care, fill gaps in patient’s care, and
manage chronic disease.
While SBC made great strides on clinical initiatives they realized there was a missing piece–their RAF scores did not accurately match up to their patient population. Their patients were sicker than their RAF scores indicated.
The goal: Cost-eﬀectively Increase RAF scores.
"In a single week we saw an additional $100K+ in otherwise missing RAF value by using the RCxRules HCC Coding Software. With RCxRules, we were easily able to scale up with value-based contracts. The value of RCxRules software is unprecedented, in fact, it’s a necessity for any organization with risk-based contracts."
SBC hired a single HCC coder to concurrently review value-based encounters. They leveraged their coder and the RCxRules software to improve RAF scores through increased HCC capture/re-capture rates. The RCxRules software automated the review of 100% of SBC’s HCC encounters pre-claim to ensure the most accurate HCC data was captured and submitted. By flagging HCC coding gaps, the coder focused solely on high-value encounters needing extra attention.
By implementing RCxRules software, The South Bend Clinic achieved:
The South Bend Clinic, located in South Bend, Indiana, has nearly 150 providers, comprised of almost 30 different board certifications. Founded in 1916, the patient-centered organization has been serving their community for over 100 years.