Buried in Outdated & Redundant Gap Data?

In today’s value-based care (VBC) landscape, accurate coding is more than a reimbursement issue—it’s a foundation for quality care, audit protection, and financial sustainability. Yet many medical groups find themselves drowning in outdated, redundant data as they attempt to close Hierarchical Condition Category (HCC) gaps.

This challenge is particularly acute for provider organizations collaborating with MSOs, health plans, and ACOs. These partners often supply massive volumes of claims-based data intended to support risk adjustment. However, this data is frequently stale—filled with already-addressed diagnoses, acute conditions that have long resolved, or ICD-10 codes that no longer count under updated CMS risk models like HCC v28. Despite these shortcomings, providers are still expected to reconcile every record using disparate proprietary platforms, imposing a heavy administrative burden with little clinical benefit.

To make matters worse, claims data often lags behind the actual care by up to three months. This time gap makes it difficult to close real-time care gaps, identify current risk conditions, or address the most acute patient needs. Simultaneously, many EHRs still suggest outdated codes from retired HCC versions, leading to inaccurate RAF scores and jeopardizing performance in VBC contracts.

Outdated Workflows, Unsustainable Burdens

What starts as an attempt to support HCC capture becomes a logistical headache for providers and administrative teams alike. Staff must log into multiple portals, sift through questionable data, match claims to current clinical records, and re-document diagnoses—often manually. Not only does this waste time and resources, but it also undermines coding accuracy and fails to deliver the one thing value-based care depends on: actionable, timely insights.

The reality is clear—manual, claims-driven processes were never designed to support today’s complex risk adjustment environment. Providers need smarter tools that align with their workflows and surface clinically meaningful opportunities when they matter most: at the point of care.

ForeSee ESP® by ForeSee Medical was purpose-built to solve the inefficiencies of today’s risk adjustment workflows by replacing fragmented, manual processes with a unified, intelligent solution that integrates seamlessly into existing EHR systems. By aggregating data from claims, CMS reports, PDFs, and HIEs, ForeSee ESP® creates a comprehensive, longitudinal patient record. Its proprietary NLP and disease-suspecting medical algorithms surface real-time HCC coding gaps and undiagnosed chronic conditions that are both clinically relevant and codable at the point of care.

Providers receive these insights through intuitive “disease cards,” making it easy to document the right diagnoses during each encounter. The platform also delivers built-in CDI tips, highlights compliance risks, and increases chart review efficiency by up to 20x. With performance dashboards for administrators and intelligent patient panel triage tools for care teams, ForeSee ESP® drives smarter coding, stronger compliance, and better outcomes across the board.

Measurable Impact, Smarter Care

The results speak for themselves. Clients leveraging ForeSee ESP® consistently report improvements in documentation accuracy, risk adjustment performance, and patient outcomes. By enabling earlier diagnosis and treatment, the platform enhances the quality of care while reducing the burden of retrospective chart chases and unnecessary documentation loops.

Perhaps most importantly, ForeSee ESP® ensures that claims reflect the true disease burden of the patient population. This not only safeguards revenue and maximizes RAF score capture, but also proactively reduces the risk of RADV audits and associated financial penalties.

Across the board, medical groups using ForeSee ESP® experience stronger performance in value-based contracts, more efficient operations, and a compelling return on investment—often reaching double digits.

In an environment where every risk adjustment decision impacts care, compliance, and compensation, relying on lagging claims data and outdated coding models simply doesn’t cut it. ForeSee ESP® delivers the real-time, intelligent support providers need to document accurately, code compliantly, and succeed in value-based care.

Blog by: The ForeSee Medical Team