# Risk Stratification for Value-Based Care at Patient Onboarding

Value-based care teams can use claims retrieved through Flexpa as one input to risk stratification at patient onboarding. With patient authorization, Flexpa retrieves available history from supported health plans. Review recorded diagnoses and utilization alongside a clinical assessment, and do not assume that the available claims represent the patient's complete history.

How it works: Patient authorizes a supported plan -> Retrieve available claims -> Clinical team reviews risk. Use claims alongside clinical assessment and follow up on gaps in the available record.

## What to review

- Diagnoses and procedures recorded in available claims.
- Service dates and encounter history for utilization review.
- Provider and pharmacy information where supplied by the plan.

## Before using a baseline

Check the history's coverage period and missing sources. A missing claim is not proof that a service did not occur. Do not describe an incomplete claims history as a complete quality or utilization baseline.

## Questions

**How can providers get a new patient's claims history?** A patient can authorize a supported health plan through Flexpa Consent. The provider's integration can retrieve available records from that plan for onboarding review. The records returned depend on the patient's connected source.

**What data can inform risk review?** Flexpa can return EOBs and other available records containing diagnosis, procedure, pharmacy, encounter, and coverage information through its FHIR R4 API. Fields vary by source, and the clinical team must interpret the records alongside its own assessment.

## More

- [Providers](https://www.flexpa.com/solutions/providers)
- [Value-based care one-pager](https://www.flexpa.com/one-pagers/value-based-care)

Last updated 2026-11-11.