CMS reimburses an organization for its members based on their documented clinical factors. A patient with $1,000 worth of issues that only has $750 of documented issues is only worth $750 to CMS in reimbursement. It is therefore crucial that documentation keeps up with reality to ensure that an organization is receiving its appropriate compensation for its risk.

This requires:

• Coordinating with and rewarding physicians
• Having appropriate programs to maximize potential benefit to members
• Tracking thoroughly all educational and outreach programs (physicians, members, etc.)
• It is imperative that this endeavor be primarily a clinical program and not focused on financial gains