EHR-Connected HCC/RAF Risk Stratification for Population Health Teams
Surface care gaps, recapture opportunities, and risk signals across every patient panel.
QuickIntell connects EHR demographics, diagnoses, clinical notes, and coding outputs to support defensible HCC/RAF scoring, care-gap prioritization, and source-linked review. ACO administrators, MSO operators, Medicare Advantage teams, and health systems can coordinate outreach, review high-impact cases, and write finalized risk profiles back through EHR integration.
Review-ready risk workflow
How QuickIntell Stratifies Risk
The platform moves from raw clinical and claims data to a reviewer-approved risk profile with the model version, validation checks, hierarchy decisions, and source evidence preserved.
Ingest EHR and Claims Data
Pull demographics, diagnoses, encounter notes, coding output, and available claims context into one patient view.
Validate ICD-10 Inputs
Run Medicare Code Editor checks, including age and sex edits, before an ICD-10 code can affect scoring.
Crosswalk to HCCs
Map ICD-10 codes through the HCC crosswalk and show dual-mapped or noncontributing conditions for reviewer context.
Apply CMS-HCC v28
Use the selected CMS-HCC model, including v28 where applicable, with payment-year and segment context.
Apply Hierarchy
Suppress lower-weight related HCCs when CMS hierarchy rules require a dominant condition to stand.
Calculate RAF
Combine coefficients, demographic factors, and normalization logic into a traceable RAF result.
Route Human Review
Send high-impact, low-confidence, or policy-defined cases to coder and clinical review before finalization.
Write Back to EHR
Return finalized HCCs, RAF scores, care-management flags, and review notes to the connected EHR workflow.
Maximize Value-Based Care Performance
Support care-gap closure with point-of-care insights for patient encounters
Reduce documentation busywork with AI-powered notes and care plan generation
Track provider performance across RAF capture, quality, utilization, and review workflows
Unlock the Power of Unified Data
Make data-driven decisions with our Data Activation Platform, which integrates, unifies, and processes data from multiple sources to provide actionable insights for risk adjustment, care-gap review, and population health operations.
Platform Capabilities
- • Configurable clinical and financial data mapping
- • Source-linked patient and provider records
- • EHR, claims, coding, and analytics integration
- • Review-ready exports and operational dashboards
Population Health Analytics
Gain a 360-degree view of your patient population to identify risks, gaps in care, and opportunities for intervention. Our analytics engine processes data from multiple sources to provide actionable insights.
Risk Identification
Predict high-risk patients and emerging health issues early.
Gap Analysis
Detect missed care opportunities and enable preventive action.
Intervention Planning
Design targeted strategies to improve outcomes across populations.
Dashboard-first operations
Product-Led Views for Recapture, RAF, and Contract Work
Population health, risk adjustment, and contract teams can work from saved views that turn panel-level data into drillable work lists, provider coaching views, and exportable reporting sets.
For rollout planning, pair these workflows with the HCC coding guide and the QuickIntell implementation team's current workflow validation guidance.
Built for review cycles
- Recapture gaps prioritized by panel and source evidence
- RAF capture trends by provider, plan, location, and cohort
- CSV exports for finance, quality, and audit workflows, plus ROI modeling for leadership review
Population Risk Dashboard
Saved view: MA panel, current year
Recapture gaps
Filter, compare, drill down, and route follow-up from the same operating view.
RAF capture trends
Filter, compare, drill down, and route follow-up from the same operating view.
Care gaps
Filter, compare, drill down, and route follow-up from the same operating view.
Provider scorecards
Filter, compare, drill down, and route follow-up from the same operating view.
Payer analytics
Filter, compare, drill down, and route follow-up from the same operating view.
Contract analytics
Filter, compare, drill down, and route follow-up from the same operating view.
Saved views
Filter, compare, drill down, and route follow-up from the same operating view.
Source drilldowns
Filter, compare, drill down, and route follow-up from the same operating view.
Key Features
Risk Adjustment
Maximize performance with AI-powered gap identification and coding accuracy.
Quality Management
Improve quality metrics with real-time data measurement, reporting, and submission.
Care Management
Deliver personalized care with AI-assisted workflows, automated gap detection, and coordination tools.
Contract Management
Drive value-based care success with financial modeling, performance tracking, and scenario analysis.
Data Activation Platform
Our platform transforms raw data into actionable insights through a simple five-step process.
Integrate
Collect raw data from all source systems into a unified data lake, eliminating silos.
Harmonize
Standardize and clean data structures for consistent, usable information.
Unify
Merge patient and provider records into a single source of truth.
Process
Apply intelligent algorithms to enrich data with deeper insights.
Analyze
Turn data into multidimensional cubes for advanced analytics and AI-driven decisions.
Operational Focus Areas
Prioritize open care and recapture opportunities by patient panel.
Surface high-risk patients and emerging utilization patterns.
Route care-management follow-up to the right team.
Connect HCC evidence, reviewer decisions, and audit trails.
Performance Signals
Monitor capture trends and review priorities.
Track year-over-year recapture gaps.
Link every captured condition to source evidence.
Integrations and trust
Connect Risk Workflows Without Losing Control
QuickIntell keeps EHR sync, reviewer decisions, PHI controls, and audit history visible so risk teams can move quickly while preserving a defensible record.
Supported EHR Paths
Supported connectors include OpenEMR, Epic, Cerner, Athena, eClinicalWorks, NextGen, Allscripts, and DrChrono, with FHIR and REST pathways where available.
Default sync cadence: 15 minutes
Conflict and Audit Workspace
Field conflicts can route to a side-by-side resolution workspace, and reviewer activity is captured in audit logs with timestamps, source records, and decision history.
Designed for source-linked review
PHI Safeguards and BAA
PHI safeguards include encryption, role-based access, tenant isolation, audit logging, and covered-workflow BAA support.
Visit the Trust CenterFrequently Asked Questions About Population Risk
QuickIntell combines EHR, claims, coding, and clinical context to help teams prioritize patients by HCC/RAF opportunity, care gaps, and review urgency. The output is designed to support coder and clinical review, not replace it.
The workflow maps ICD-10 diagnosis codes to HCCs, applies the selected CMS-HCC model such as v28, evaluates hierarchy rules, and shows the source evidence and model version behind each scored condition.
QuickIntell can prepare review-ready risk adjustment exports and submission support artifacts for RAPS/EDPS workflows when configured. Final submission decisions remain with the customer team under applicable payer and CMS requirements.
Typical inputs include patient demographics, encounter diagnoses, problem lists, clinical notes, labs, medication context, coverage data, and finalized coding output. Claims feeds can be added where available for longitudinal recapture and utilization context.
QuickIntell validates candidate codes with Medicare Code Editor checks such as age and sex edits, maps valid ICD-10 codes through the HCC crosswalk, applies CMS hierarchy logic, and records why any code or HCC was excluded.
Borderline, high-impact, or customer-defined cases can route to a human review queue. Reviewers can accept, modify, or reject suggested HCCs, add documentation notes, and lock the finalized RAF result with reviewer attribution.
Yes. QuickIntell surfaces recapture candidates, open care gaps, and patient-panel priorities with links back to the supporting encounter, diagnosis, note, or claims context so teams can review the evidence before taking action.
Teams can monitor recapture gaps, RAF capture trends, care gaps, provider scorecards, payer and contract analytics, saved views, drilldowns to source records, and CSV export workflows for operations and reporting.
Audit exports can include the source encounter, ICD-10 code, mapped HCC, CMS-HCC model version, hierarchy decision, reviewer action, timestamps, and related evidence links so teams can assemble defensible review packets.
After review, finalized HCC lists, RAF results, care-management flags, or supporting notes can write back through the configured EHR connector. FHIR and REST pathways are used where supported by the source system.
QuickIntell uses HIPAA-aligned safeguards including encryption in transit and at rest, role-based access, audit logs, tenant isolation, and PHI-scoped operational controls. BAAs are available for covered workflows.
Impact depends on panel mix, contracts, documentation quality, workflow adoption, and review policies. QuickIntell provides baseline views, source-linked gaps, and exportable evidence so teams can measure results against their own operating data.
See EHR-Connected HCC/RAF and Care-Gap Workflows Live
In a 30-minute demo, we will walk through de-identified EHR inputs, HCC/RAF validation, care-gap prioritization, reviewer queues, audit evidence, and EHR write-back so your team can see how the workflow would run against your operating model.