HCC risk adjustment software

Milliman ACO Builder Risk Score Benchmarking

ACO Builder Risk Score Benchmarking helps Medicare organizations identify coding gaps and optimize hierarchical condition category (HCC) risk adjustment. The tool compares risk scores across providers, payers, geographies, and Centers for Medicare and Medicaid (CMS)-HCC versions (v24 and v28). With access to 100% Medicare fee-for-service (FFS) data, users gain visibility into HCC risk capture and chronic recapture rates at both provider and population levels to help identify opportunities for improvement and additional investment.

Milliman ACO Builder Risk Score Benchmarking

THE CHALLENGE

Inaccurate coding reduces Medicare revenue

Medicare Advantage (MA) organizations, accountable care organizations (ACOs), and risk-sharing providers depend on accurate HCC risk adjustment coding to align payment with patient risk. Yet many groups struggle to track risk scores across providers or identify underperformance. Without benchmarks or recapture visibility, teams miss revenue and misallocate coding resources.

THE SOLUTION

Benchmark risk scores with precision

As part of the ACO Builder suite, Risk Score Benchmarking supports organizations seeking risk adjustment tools to manage HCC risk adjustment coding more effectively across Medicare populations (FFS and MA). Risk Score Benchmarking delivers sharp, provider-level insight into HCC risk patterns and coding performance. Teams can pinpoint gaps, compare results to regional and national peers, and evaluate the impact of CMS-HCC v28 on revenue. Built to guide targeted interventions, the platform equips organizations to act decisively on HCC risk adjustment and drive measurable financial improvement.

BENEFITS

Benefits of Risk Score Benchmarking

Use provider— and population—level insights to focus risk management efforts where they matter most.

Accelerate contract reviews

Use provider— and population—level insights to focus risk management efforts where they matter most.

Improve coding accuracy

Understand HCC risk adjustment patterns across CMS-HCC versions.

Target recapture improvement

Analyze chronic condition HCC risk recapture rates against regional and national benchmarks.

Support revenue planning

Quantify the financial impact of coding differences under v24 and v28, as well as understand the potential financial implications of coding improvements moving forward.

FEATURES

Features of Risk Score Benchmarking

Provider-level benchmarks

Drill down to individual providers and compare risk scores regionally and nationally by HCC.

Multiple attribution models

View results for MA, Medicare Shared Savings Program (MSSP), and ACO Realizing Equity, Access and Community Health (REACH) populations using Milliman (MA) and CMS-defined (MSSP and ACO REACH) logic.

Side-by-side model comparison

Track HCC risk adjustment under both v24 and v28 to assess coding shifts.

Recapture analytics

View HCC risk recapture rates for chronic conditions and compare against regional benchmarks.

Excel-based delivery

Access outputs in familiar formats for easy review, modeling, and planning.

Expert consulting support

Milliman consultants help interpret results and guide coding strategy.

Milliman ACO Builder Risk Score Benchmarking