Gartner Research

5 Actions U.S. Healthcare Payer CIOs Must Take When Purchasing Risk Adjustment Management Systems

Published: 31 January 2019

ID: G00369402

Analyst(s): Mandi Bishop , Bryan Cole


Profitability in government health programs depends on complete and accurate coding of members’ health status. U.S. healthcare payer CIOs must prioritize analytics and verify AI capabilities when seeking new or replacing risk adjustment optimization vendors.

Table Of Contents
  • Key Challenges


  • Government Health Program Profits Depend on Smart RAO Vendor Selection
    • RAO Is Not an Easy Market for Payer CIOs to Navigate
    • CIOs Must Expand Knowledge of RAO Vendors and Market Dynamics


  • Seek Vendors With Differentiated Analytics Capabilities
  • Make Vendors Use Your Data to Demonstrate Their Capabilities
  • Probe the Strengths and Weaknesses of Vendors’ AI Tools
  • Evaluate Buying RAO and Quality Improvement From One Vendor
  • Invest in CDI

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