In value-based care (VBC), the problem list is more than a clinical tool — it’s a financial asset. However, incomplete documentation, nonspecific coding, and siloed payer insights can make it difficult for providers to code accurately and confidently. In this webinar, experts from IMO Health explore how purpose-built electronic health record (EHR) tools can help health systems boost risk adjustment factor (RAF) scores, prepare for RADV audits, and close chronic condition gaps — all while staying within the provider’s workflow.
Why does clinical terminology matter for Medicare Advantage?
To understand how more innovative EHR tools support risk-bearing models, you need to start with smarter data. As IMO Health’s Chief Clinical Officer, Steven Rube, MD, FAMIA, explained, standard code sets like ICD-10-CM and SNOMED® “were not created to capture clinical intent at the point of care. That is not why they exist.”
Instead, IMO Health’s terminology allows clinicians to document what they actually mean, even when existing code sets don’t go deep enough.
“Our job is to let clinicians express themselves the way they were taught in medical school… not to make them think about what SNOMED wants them to say,” Rube said.
A reimagined problem list can drive risk adjustment
David Arco, IMO Health’s Director of Product Management, demonstrated how the company’s EHR-embedded application transforms the problem list into a strategic tool.
Rather than sorting by date or alphabetically, conditions are grouped by clinical category, and hierarchical condition categories (HCCs) are flagged based on whether they’ve been coded that calendar year. A built-in cleanup feature helps remove outdated diagnoses — like an old acute myocardial infarction (MI) — and surfaces chronic conditions that may have been missed.
“This doesn’t happen today because EHRs don’t really have tools to assist with this,” David said. “It’s a manual effort… and so it frankly doesn’t happen.”
What’s the impact of more specific coding?
In a live demo, Arco showed how a basic diabetes code (E11.9) can be enhanced through a few guided questions into a fully specific code that reflects insulin use and stage 4 Chronic Kidney Disease (CKD). That change alone drove a RAF increase from 0.166 to 1.49 — illustrating the tangible value of capturing the full clinical picture.
“Previously, I would’ve coded the diabetes, but probably an E11.9, lower RAF score. I wouldn’t have coded the CKD. I probably wouldn’t have seen the CHF. And I probably wouldn’t have seen thrombocytopenia. I might have coded an acute MI and invited an audit,” Arco explained. “Now I’ve gone from a 0.166 RAF to almost 10x in RAF with these HCCs.”
Are payer insights being used at the point of care?
They can be when delivered the right way. IMO Discovery integrates payer-sourced HCC suggestions directly into the provider’s EHR workflow, instead of relying on inbox messages or external alerts.
“We’re not just adding pop-ups or alerts,” Arco noted. “We’re embedding actionable insights into the tools providers already use.”
That visibility makes it easier to identify suspected or externally coded conditions and address them during the encounter.
What a successful implementation looks like
Technology alone isn’t enough — adoption matters. Sriram Talluri, MBA, IMO Health’s Product Sales Director, shared the organization’s change management framework, which includes tailored implementation support, pilot testing with clinician champions, and ongoing education and office hours.
“We understand there’s a need for customizability,” he explained. “No two health systems are alike, just like no two diabetic patients are alike. That’s why we tailor each rollout to the organization’s resources, education model, and goals.”
How can organizations align clinical and financial teams around documentation?
According to Rube, documentation accuracy shouldn’t be seen as just more administrative work — it’s a cornerstone of quality care and risk model success.
“This is not just something else that we’re heaping on your shoulders,” he said. “These systems can be very smooth, very integrated… and they make for a more financially and clinically excellent institution.”
With smarter tools and leadership support, providers can capture patient complexity without increasing burden.
Ready for RADV audits?
With CMS increasing RADV audit activity, health systems need tools that support accurate documentation, not just coding.
IMO Health’s embedded workflows help avoid common pitfalls like recording outdated conditions (e.g., old acute events) and ensure that supporting evidence — such as medications and labs — is readily accessible. The goal? Avoid overpayments and protect your organization from audit exposure.
Ready to future-proof your documentation strategy for value-based care?
Get a demo of IMO Health’s point-of-care workflow solutions.
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