Risk Adjustment

RAF Score Optimization Program

Regional Medicare Advantage Health Plan | 150,000 Members

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 Achieved

18%
RAF Score Improvement
$12M
Annual Revenue Impact
45%
Gap Closure Rate
Quality & STARS

STARS Rating Improvement Initiative

National Health Plan | Multi-State Operations

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 Achieved

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

High-Risk Member Management Program

ACO Network | 75,000 Attributed Lives

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 Achieved

22%
ER Visit Reduction
$4.2M
Annual Savings
40%
Engagement Rate Increase
Business Intelligence

Enterprise BI Platform Implementation

Healthcare Technology Company

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 Leadership was making decisions based on outdated spreadsheets and manual reports.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 Achieved

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

BFI 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

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