Rigorous patient scheduling critical to success in a risk adjustment environment

By Jason Jobes, SVP, Solutions

Best Practice Tip: On January 1^st of every year identify what percentage of your patients’ risk-based contracts have a scheduled PCP appointment.

As full implementation of V28 of CMS-HCCs looms larger, I want to share a best practice I discuss with our partners. What percent of your patients have their next visit scheduled when they leave their current office visit?

Here is a look at one of our partners (See graphic below). In 2022 we discussed improving the scheduling process for the patients that they have in risk-based contracts. The idea was that healthy patients should at least have an annual wellness visit or physical scheduled, and those with chronic conditions should have follow-up visits.

This organization over the last two years has made some solid strides in improving the check-out process and scheduling patients for their next visit. In 2024 we looked at the percent of the known chronic conditions that were captured for those who entered 1/1/2024 with a visit scheduled vs those that didn’t. The patients with visits that were on the books by 1/1 drastically outperformed those who didn’t have a visit scheduled.

So, how does your organization do? Are you even focusing on what percent of patients have appointments? How are you focusing on the other processes besides just documentation to drive risk success?

For 2026—year one of V28—I recommend on the first day of the year you run a report of the patients in your risk pool and if they have a visit scheduled with their PCP. Track performance across the year and track the outcomes.

Some organizations wait to do this until the last quarter of the year. I recently had a great conversation with an organization who does incredibly well on that in Q4. I asked them why they waited. They said because there were outstanding gaps and the patients hadn’t been seen that year. I applauded their efforts … and then asked how they were ensuring the patients received continuous care for their chronic conditions throughout the year. The silence was deafening.

If you need help with your risk program or want to hear more about any of the other 45 best practices we have on hand, let’s talk!

Cheers to 2026.

Contact me at jason@norwood.com.