Improve care management using HCCs

Drive risk-adjustment documentation and care management of patient populations with the only complete, artificial intelligence (AI) powered Hierarchical Condition Category (HCC) solution suite. M*Modal’s patient-focused and quality-centric HCC management solutions help risk-bearing healthcare organizations proactively meet the challenges of the HCC model by accurately capturing the appropriate severity of illness and Risk Adjustment Factor (RAF) scores.

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Drive outcomes with our widely-adopted, AI-powered Clinical Documentation Improvement (CDI) solutions

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Successfully manage both acute and ambulatory care patients with chronic conditions using the HCC framework.

Using AI and natural language understanding (NLU) technologies, our solutions bring in-workflow clinical intelligence, automation and workflow efficiencies that can scale to the larger volume of ambulatory-care documentation.

HCC Engage HCC Collaborate RAF Score Management


By leveraging widely-adopted, AI-driven Computer-Assisted Physician Documentation (CAPD) that works with all market-leading EHRs, we deliver to physicians real-time insights on HCC opportunities and codes as well as patient disease states, problems and care needs at the point of care.

  • Physician Engagement

    By providing physicians with patient-specific information related to chronic conditions in preparation for the patient visit, we deliver sustainable support to physicians in creating fully-specified notes the first time around, and within the normal EHR documentation workflow.

  • Creating Time to Care

    Our unique solution proactively assists with summarizing patient-specific goals and requirements in connection with value-based care across multiple systems in the practice environment. Along with real-time clinical insights, this enables front-line action that captures the patient’s disease states, minimizes retrospective queries and avoids rework, thereby significantly boosting the productivity of both physicians and auditors.

  • Value-Based Care

    HCC Engage ensures that physician documentation on chronic conditions such as diabetes, hypertension, stroke, etc. is complete and compliant. This game-changing solution enables clinicians to capture the most specific disease categories for optimal quality and reimbursement.


HCC Collaborate is an auditing workflow management solution that continuously analyzes and monitors all patient charts for optimal HCC coding and reporting, and provides a single-access web interface for multiple stakeholders to manage the patient year over year.

  • Patient Prioritization

    HCC Collaborate enables the automated prioritization of patients who need to be scheduled based on outstanding gaps in risk-adjustment diagnoses that need to be captured in the current calendar year. These real-time prioritized worklists based on gaps in patient risk scores are designed to drive targeted scheduling and audits.

  • Identifying Opportunities and Gaps

    This advanced solution helps auditors quickly and accurately identify potential risk-adjustment opportunities by using AI and NLU technologies to analyze previous years’ claims, EHR structured data, and narrative clinical documentation.

  • Auditing and Summarized Evidence

    Automated summaries of clinical indicators based on the patient’s entire history streamline the claim audit workflow and deliver unparalleled consistency and efficiency. Robust pre-submission auditing tools along with detailed reporting help to continually improve risk-capture protocols.

RAF Score Management

M*Modal has collaborated with SAS to give healthcare organizations accurate and reliable RAF scores in order to prioritize and improve care across their entire patient population.

  • Unique Insight

    Revenue cycle managers gain transparency into population RAF scores and gaps that are otherwise cumbersome to find and identify. With this information, auditors can immediately identify gaps in the capture of chronic conditions from year to year, as well as find additional HCC opportunities.

  • Using CMS Data Models

    This solution gives healthcare organizations a true and accurate risk score based on the same data models used by CMS (Centers for Medicare & Medicaid Services) and a complete understanding of each patient’s true severity of illness.