There is a better way to carry out risk adjustment than constantly staring in the rearview mirror. Prospective risk adjustment solutions look ahead to the patient encounter, using medical and pharmacy claims as well as other data sources (e.g., lab results, EMR problem lists, etc.) to identify conditions that are likely to exist but have not been coded. Then, at the patient visit, providers are prompted to confirm or deny those conditions, and document them accordingly. Prospective solutions to risk adjustment have a greater degree of difficulty than retrospective approaches. They require advanced technology, as well as effective methods to spur provider behavior change and the culture of physician practices. But when they are done right, these tactics come together not only to improve the effectiveness of a risk adjustment program, but to transform it from a back-office, financial task to a member-focused activity with benefits beyond accurate reimbursement.

A prospective risk adjustment program not only pushes suspect conditions to physicians at the point of care, but also provides regular analytics and feedback to help them track their performance. By making documentation issues more top-of-mind, prospective approaches encourage providers to reflexively consider whether there is a new diagnosis to document or an older one that needs reconfirmation.