Value-Based Care
Risk that reflects reality.
OptimIQ reads every encounter and turns it into defensible risk and quality evidence — so your RAF reflects the patients you actually treat, and every code holds up the day the audit arrives.
Value-Based Care · Risk Capture · Panel 4,812
CMS-HCC V28 · CY2025 · refreshed 14:02- E11.22Diabetes with CKDnote + labs
- I50.32Chronic diastolic heart failurenote + echo
- N18.31CKD stage 3anote + eGFR
- Epic
- Oracle Health
- athenahealth
- Veradigm
- eClinicalWorks
- HL7 / FHIR
- CMS-HCC V24 + V28
- HEDIS MY2025
- CMS Stars
- RADV
- X12 837 / 835
Revenue and care, measured the same way.
Four jobs that usually live in four tools. OptimIQ runs them on one set of facts, so nothing drifts between them.
Suspected and recapture HCCs, evidenced from the chart.
HEDIS and Stars gaps beside the risk picture.
Every code linked to the sentence that supports it.
Capitation and shared savings, modeled live.
The anatomy of a value-based signal.
Every suspected condition and open gap arrives with the evidence to act on it — and the trail to defend it later.
- Suspected HCC · E11.22Evidence ready0.91
- Care gap · Eye examOpen612
- RADV flag · I50.32Documented✓
Surfaced from the chart
Notes, labs, and feeds, read continuously.
Audit-ready by default
Every documented code carries its MEAT trail.
Only what's provable
Suspected codes wait until the chart supports them.
One click to close
Draft orders sit in the same row as the gap.
Scores recompute the moment new evidence lands — no quarter-end surprises.
HEDIS and Stars gaps tracked right beside the risk picture.
Code what the chart can prove.
OptimIQ reads notes, labs, problem lists, and feeds to surface suspected HCCs — then holds each one until the documentation supports it. What reaches your RAF is what an auditor can verify.
- Progress note03/14 · endocrinology
- Lab resultA1c 9.2% · 03/12
- Problem list12 active conditions
- Echo reportEF 38% · cardiology
1.847
+0.214vs. submitted
- Every code traced to source
- RADV-ready packet on file
The whole panel, on one screen.
Risk, quality, and economics in one view — every number traceable to the chart underneath, and every gap one click from closing.
14 care gaps are ready to close before today's visits — drafts attached to each chart.
$75 PMPM under benchmark · tracking to shared savings
Suspect, code, and defend — in one platform.
See it on your chartsOptimIQ reads the chart, suspects HCCs with the evidence already attached, computes RAF under the current CMS models, and keeps every code audit-ready — with your coders in control at every gate.
The engine drafts codes with confidence scores; your coders approve through QA, SME, and audit gates before anything is submitted.
“…A1c 9.2%, up from 8.1%— metformin continued, dose adjusted…”
Every code links to the exact sentence, page, and date of service that supports it — affirmed, current, and about your patient.
Hierarchy pruning, interaction scoring, and ESRD and RxHCC variants — matched to the right fiscal year per date of service.
Monitoring, evaluation, assessment, treatment — every code scored against the documentation before it counts.
Unspecified codes upgraded when the chart supports stage, laterality, or etiology — never the other way around.
Billability, hierarchy, and coding-risk checks on every submission — with a defensible packet per code.
Built for ACOs, MSOs, and at-risk medical groups. Every chart tracked from ready-for-coding through QA, SME review, and submission.
Get startedThe infrastructure behind every signal.
One pipeline turns each encounter into defensible risk and quality — secure ingestion, isolated models, and an evidence trail built for the audit.
Audit-ready the moment it's coded.
Progress note
03/14/2025 · A. Reyes, MD · Endocrinology
58-year-old established patient returns for diabetes follow-up. A1c 9.2%, up from 8.1% in December — metformin continued, dose adjusted. Retinal screen and foot exam ordered. eGFR 52, consistent with CKD stage 3a; recheck in 12 weeks.
Assessment & plan
Signed — A. Reyes, MD · attested 03/14/2025
How does patient attribution work?
Will it fit our EHR?
How is a code defended in a RADV audit?
How fast can we go live?
Does it replace our coders?