Based on our calculations, approximately 20 percent of members in a given population aren’t accurately risk adjusted. Which is surprising given the investment health plans have made in solutions like chart-chasing, in-home visits and data mining.

Here’s the thing: those efforts are only as productive as the members who go to the doctor, and the quality of those visits once they do. When you consider the value of each hierarchical condition category (HCC), and the average number of HCCs per member, the members who aren’t getting accurately coded could be costing you. Use the calculator below to find out approximately how much revenue you might be missing.

Annual Wellness Visits (AWVs) are a key opportunity to identify HCCs, which help determine risk adjustment payments from CMS. If your members aren’t going to their providers, your current approaches won’t help.

At NovuHealth, we take a member-centric approach to risk adjustment by motivating the members who need to be coded and empowering them to have a more productive AWV with their physician. It’s a fundamental shift in how plans capture risk adjustment revenue, but it can also make your existing efforts more accurate and productive.

To learn more about how member engagement can help optimize your current risk adjustment approach, and to get 5 effective strategies for reducing unknown risk, download our presentation from RISE Nashville.


About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at

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