Risk Adjustment · Illustrative Engagement

RAF Score Optimization Program

Methodology pattern — applicable to MA plans and provider-owned ACOs in MSSP / REACH

The Challenge

The health plan was experiencing significant RAF score leakage due to incomplete condition capture. Their existing analytics team lacked the specialized expertise to identify and address coding gaps effectively.

Our Approach

  • Comprehensive HCC gap analysis across all members
  • Provider education program with targeted outreach
  • Retrospective chart review prioritization model
  • Real-time coding accuracy dashboards

Key Deliverables

  • Automated HCC gap identification system
  • Provider scorecards and benchmarking
  • Executive dashboard suite
  • Coding education materials

Results Pattern

0
RAF Score Improvement
0
Annual Revenue Impact
0
Gap Closure Rate
Quality & Stars · Illustrative Engagement

Stars Rating Improvement Initiative

Methodology pattern — applicable to MA plans and ACOs with MA-aligned populations

The Challenge

A 3.5-star plan needed to reach 4 stars to remain competitive and earn quality bonuses. They lacked visibility into member-level gaps and struggled with intervention prioritization.

Our Approach

  • Member-level HEDIS gap analysis
  • Predictive modeling for intervention ROI
  • Provider performance analytics
  • Weekly monitoring dashboards

Key Deliverables

  • STARS simulation tool
  • Care gap prioritization engine
  • Provider engagement scorecards
  • Executive reporting suite

Results Pattern

4.0★
Star Rating Achieved
35%
Gap Closure Improvement
$8M
Quality Bonus Earned
Population Health · Illustrative Engagement

High-Risk Member Management Program

Methodology pattern — directly applicable to ACOs managing two-sided risk

The Challenge

The ACO was struggling to identify and engage their highest-risk members effectively. Limited analytics capabilities meant care managers were working from incomplete data.

Our Approach

  • Predictive risk stratification model
  • Social determinants data integration
  • Care manager workload optimization
  • Outcomes tracking framework

Key Deliverables

  • Risk stratification engine
  • Care manager dashboard
  • Patient profile summaries
  • ROI tracking system

Results Pattern

22%
ER Visit Reduction
$4.2M
Annual Savings
40%
Engagement Rate Increase
Decision Support · Illustrative Engagement

Decision Support Platform Build-Out

Methodology pattern — applicable to ACOs and health plans rebuilding their analytics stack

The Challenge

The organization had data scattered across multiple systems with no unified view. Leadership was making decisions based on outdated spreadsheets and manual reports.

Our Approach

  • Requirements gathering and KPI definition
  • Data architecture design
  • Tableau dashboard development
  • Self-service analytics training

Key Deliverables

  • Executive dashboard suite
  • Operational KPI framework
  • Data governance documentation
  • User training program

Results Pattern

80%
Faster Reporting
50+
Dashboards Delivered
100%
Adoption Rate

BFILABS.AI delivered enterprise-quality analytics at a fraction of what we would have paid the big consulting firms. Their hands-on approach and deep healthcare expertise made all the difference.

Chief Analytics Officer

Regional Health Plan

Ready to Write Your Success Story?

If your ACO is wrestling with any of these patterns, we'd be glad to walk through your specific situation. We're actively partnering with our first ACO clients.

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