Turn telehealth & in‑home encounters into top‑quartile RAF results.
Anonymous, cohort‑matched benchmarks for value‑based care operators.
Built for value-based care operators across in-home, virtual, and provider-group settings. See exactly how your RAF capture and documentation sufficiency stack up to matched peers — then get a prioritized plan by provider panel, HCC family, and channel (in‑home vs virtual). No PHI. Compliance‑first.
- Blinded peer comparison
- Cohort‑matched percentiles
- No PHI • 90–180 day data lag
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RFP win-rate ↑Blinded percentiles you can cite (e.g., “Top‑quartile DAI — Duals cohort”).
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Revenue capture ↑0.05–0.15 RAF delta (modeled) from the same visit volume by fixing recapture + evidence gaps.
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RADV exposure ↓Quantify exposure in $/bps; prioritize NP/PA panels where QA cuts audit risk fastest.
What you’ll know on Day 1
Sample- • RAF per 100 visits & acceptance rate percentile vs matched peers
- • Documentation Accuracy Index (DAI) — low‑evidence HCC families to fix first
- • RADV exposure (modeled $/bps) + top 5 NP/PA panels to retrain
- • Channel mix opportunity — where in‑home vs virtual changes lift capture
Never: names, exact DOB, charts, notes, claim/control numbers, or any PHI.
Compliance‑first governance
HIPAA Expert Determination de‑identification. Cohort thresholds (e.g., ≥5 contributors; max 20–25% share per cell), differential‑privacy noise, and small‑cell suppression. 90–180 day data lag. Neutral advisory and antitrust counsel.
- • Legally binding participation code: no deanonymization or collusion; benchmarking use only.
- • Blinded outputs; no vendor, plan, or member identification in public views.
- • Alignment with public‑interest outcomes: audit precision, payment fairness, quality improvement, open standards.
Why this matters
The goal is to reduce under‑ and over‑payment by benchmarking documentation sufficiency and condition recapture, while helping direct RADV focus to where it has the most impact. Outputs are highly aggregated, cohort‑matched, and privacy‑preserving by default.
We are not a coding or billing service and do not alter claims. We provide blinded benchmarks and decision support to improve accuracy and audit defensibility.
Why participate
- • RFP proof, not opinions: exportable percentile badges by cohort (e.g., DAI: 76th percentile — Duals • In-Home • West).
- • Opportunity to $$: Opportunity Map ranks HCC families × provider panels by expected RAF lift and RADV exposure delta.
- • Channel Mix Optimizer: shift in-home vs virtual vs hybrid where it improves capture and audit defensibility.
- • Give-to-get: contribute de-identified extracts → unlock private benchmarks. No PHI, lagged, DP-protected.
What you unlock
- • Documentation Accuracy Index by cohort (blinded)
- • Opportunity Maps by HCC family (missed chronic recapture; low sufficiency evidence)
- • RADV Exposure Signal/Simulator (current CMS parameters) to quantify audit‑risk deltas
- • Channel Mix Optimizer (in‑home vs virtual vs hybrid) by cohort
Compliance‑first. Accuracy‑led growth. Blinded proof that survives audits.
In your first 30 days
- • Week 1: Load lagged metadata (no PHI). Get cohort-matched percentiles + RADV exposure baseline.
- • Week 2: Review Opportunity Map. Pick top 5 HCC families × provider panels.
- • Week 3–4: Run targeted documentation QA + provider refresh.
- • Day 30: Export RFP slide with new percentiles and progress deltas.
How it works
Purpose‑built for value‑based care operators. Fast setup, zero PHI.
Upload metadata
CSV/API with de‑identified encounter summaries (lagged). No PHI, ever.
We normalize & cohort‑match
Standardize, threshold, and blend to produce blinded percentiles and privacy‑preserving outputs.
Benchmark & act
Track trends, share executive‑ready reports, and focus QA where it meaningfully reduces RADV risk.
Simple, scalable pricing
Start with a one‑time snapshot. Upgrade for continuous, blinded benchmarking and provider‑level percentiles.
Free
One‑time benchmark
- • 1 peer percentile snapshot
- • National cohort only
- • Basic PDF export
Pro
Contributor access applies
- • Monthly percentiles by cohort + provider-level ranks
- • Opportunity Map with expected RAF lift and RADV exposure delta
- • Channel Mix Optimizer (in-home/virtual/hybrid)
- • Exportable badges for RFPs + email alerts
Enterprise
Rollups & private cohorts
- • Multi‑org rollups & private cohorts
- • RADV Exposure Simulator; Channel Mix Optimizer
- • SSO, API access, dedicated analyst
- • Governance & antitrust counsel participation available
Join the Waitlist
Be the first to access RAFscore when we launch on January 1, 2026.
FAQ
Do you require PHI or SOC 2?
No. RAFscore works on de‑identified, lagged encounter metadata only — never charts, names, exact DOB, or claim/control numbers. HIPAA Expert Determination de‑ID with cohort thresholds, DP noise, and small‑cell suppression.
Is this a coding or billing service?
No. RAFscore provides blinded benchmarks and decision support. We do not alter claims or submit codes. Use our outputs to target provider education and QA programs that improve accuracy and audit defensibility.
Where do the benchmarks come from?
From participating organizations who contribute standardized, de‑identified extracts. “Give‑to‑get” access means private benchmarks are available only to contributors. Cohorts are apples‑to‑apples by org type, size, region, plan, and channel mix.
How often are rankings updated?
Monthly on Pro. Enterprise can receive more frequent updates and simulators via API.
Who is RAFscore not for?
Teams seeking coding services or chart reviews. We’re a blinded benchmarking and decision-support network—no PHI, no claim edits.