The Challenge- A Risk Adjustment Project on the Brink

A healthcare consulting firm engaged Gentry Consulting to salvage incomplete risk adjustment projects before CMS-imposed deadlines. The firm’s existing workflows were fragmented and inefficient—heavily reliant on manual processes, spreadsheets, and paper charts. Staffing models were flawed, requiring a 1:1 ratio of nurses to medical coders, creating unnecessary costs and bottlenecks. These design issues resulted in missed opportunities and limited capacity to meet client needs. 

Our Role and Approach

Initially brought in to complete outstanding work, Gentry Consulting quickly identified systemic inefficiencies during lessons learned sessions. We uncovered three critical issues: 

• Workflow design biased toward certain departments, creating silos. 

• Overstaffing due to unnecessary clinical involvement in coding reviews. 

• Manual processes that hindered scalability and real-time visibility. 

We partnered with the firm to redesign workflows, integrate technology, and align cross-functional teams for efficiency and scalability. 

Solution Delivered 

• Built a centralized database to replace spreadsheets, enabling real-time tracking and automated reporting. 

• Redesigned workflows to eliminate silos and support all departments. 

• Removed unnecessary clinical staffing, reducing headcount by 90% in that category and overall staffing by more than 50%. 

• Automated project status reporting and output generation for client deliverables. 

Results & Impact 

The redesigned model tripled project capacity while operating with less than half the original staff. Scheduling and productivity tracking became precise, hourly production rates were monitored, and client satisfaction soared thanks to real-time updates and financial impact reporting. Gentry Consulting transformed siloed operations into a cohesive, scalable system that delivered measurable value.