HCC & RAF Opportunity
Risk adjustment intelligence — recapture, suspecting and revenue impact.
Open HCC Recaptures
255
+18 WoW
Suspected Conditions
149
Avg RAF (baseline)
1.14
Projected RAF
1.31
+0.17≈ $180K revenue
HCC Recapture Opportunities
revenue $ at projected payer rateRAF Trajectory
Suspected Conditions Queue
AI-inferred — pending provider validation| Suspected Diagnosis | Members | Model Confidence | Estimated RAF Lift | Action |
|---|---|---|---|---|
| Suspected CKD Stage 3 (eGFR trend) | 48 | High | +2.88 | |
| Suspected Diabetic Neuropathy | 36 | Medium | +2.16 | |
| Undocumented Vascular Disease | 29 | High | +1.74 | |
| Suspected Cardiomyopathy | 14 | Medium | +0.84 | |
| Suspected COPD (Rx + claims) | 22 | High | +1.32 |