Your prospective risk adjustment program launched successfully. Providers got alerts about documentation gaps during patient visits. Initial engagement was strong. Capture rates improved. Leadership was happy.
Twelve months later, the program is dying. Provider engagement has dropped 60%. Alerts are being dismissed without review. The documentation improvements have plateaued or reversed. Nobody talks about the program anymore.
This is the year two collapse that happens to most prospective risk adjustment programs. Here’s why it happens and how to prevent it.
The Novelty Decay Pattern
Month one after launch: Providers are curious about the new alerts. They read them. They engage. Completion rates are 55-60%.
Month three: Providers have seen enough alerts to form opinions. The helpful alerts are still getting attention. The irrelevant alerts are being dismissed faster. Completion rates drop to 45%.
Month six: Providers have developed habits. They’ve learned which alert types are usually accurate and which are usually wrong. They’re making split-second decisions about whether to engage. Completion rates are 35%.
Month twelve: Alert fatigue has fully set in. Providers dismiss most alerts reflexively. Only the most obvious, high-value alerts get any attention. Completion rates are 20-25%.
This decay pattern is predictable and nearly universal. The programs that survive year two are the ones that actively counteract alert fatigue.
The Precision Degradation Problem
When prospective programs launch, teams spend months tuning alert logic to maximize accuracy. Launch happens when precision is at its peak.
Then nobody maintains it.
Clinical guidelines change. Provider documentation patterns evolve. EHR templates get updated. Member populations shift. All of these changes degrade alert precision over time.
An alert that was 80% accurate at launch might be 55% accurate twelve months later because the underlying assumptions no longer match reality.
Providers notice. When alerts become less accurate, providers trust them less and engage less.
Most prospective programs don’t have systematic processes to monitor precision over time and retune alert logic quarterly. They launch, celebrate success, and then watch engagement slowly collapse as precision degrades.
The Volume Escalation Trap
Early prospective programs are conservative. They target high-value opportunities with strong clinical signals. Alert volume is manageable. Providers can engage without feeling overwhelmed.
Then pressure builds to increase capture. Leadership asks: “Can we expand the program to identify more opportunities?”
The team adds new alert types. Conditions that were previously excluded because signals were weaker. Lower-probability opportunities that still have some value.
Alert volume increases 40%. Alert accuracy decreases 15%. Provider engagement collapses 50%.
The math doesn’t work. Adding lower-quality alerts to increase volume actually decreases total value captured because provider engagement drops faster than alert volume increases.
Organizations that survive year two resist the temptation to keep expanding alert volume. They optimize for engagement, not alert count.
The Feedback Loop Failure
Providers dismiss alerts. But nobody asks why.
Did they dismiss because the alert was wrong? Because the patient didn’t actually have that condition? Because the condition was documented but the alert didn’t recognize it? Because they planned to document it later? Because they ran out of time?
Without understanding why alerts get dismissed, you can’t improve the system. You’re flying blind.
Most prospective programs track dismissal rates but don’t systematically collect dismissal reasons. This makes year two improvements impossible because you don’t know what to fix.
The Provider Segmentation Miss
Not all providers respond to prospective alerts the same way.
Dr. Chen loves the alerts. Her completion rate is 75%. The alerts help her remember complex patients’ chronic conditions. She wants more alerts, not fewer.
Dr. Johnson hates the alerts. His completion rate is 12%. He finds them intrusive and distracting. He’d prefer they disappeared entirely.
Most prospective programs treat all providers the same. Everyone gets the same alerts with the same frequency and the same presentation.
This guarantees that the program is poorly optimized for most providers. It’s too much for providers like Dr. Johnson and potentially too little for providers like Dr. Chen.
Organizations that survive year two implement provider segmentation. High-engagement providers get more comprehensive alerts. Low-engagement providers get only the highest-value alerts. The system adapts to each provider’s preferences and response patterns.
The Value Demonstration Gap
Providers engage with prospective alerts when they see personal benefit. Early on, the novelty provides motivation. After novelty wears off, you need to demonstrate ongoing value.
Most programs never close this loop. Providers get alerts but never see outcomes. They don’t know if their documentation improvements led to better care coordination, more accurate medication management, or improved quality scores.
Without visible value, engagement becomes pure compliance work. And compliance work without obvious purpose doesn’t sustain engagement.
Organizations that survive year two build feedback mechanisms showing providers the impact of their documentation improvements. Quarterly reports showing: “Your improved diabetes documentation helped identify 12 patients for intensive case management. Here are their outcomes.”
That creates virtuous cycles. Providers see value. Engagement increases. More value gets created.
The Technology Stagnation Problem
The prospective platform you launched with is the platform you’re still using eighteen months later. Same interface. Same alert presentation. Same workflow.
But provider needs evolved. EHR workflows changed. Competition for provider attention intensified.
Your static prospective platform is competing for attention against constantly-improving clinical decision support tools, updated EHR features, and new point-of-care applications.
Year two collapse often reflects technology stagnation. The platform that seemed cutting-edge at launch feels dated compared to newer tools providers encounter.
Organizations that survive year two invest in ongoing platform improvements. Better alert presentation. Smarter prioritization. Integration improvements. The platform evolves to stay competitive for provider attention.
What Actually Works
Preventing year two collapse requires active management, not passive monitoring.
Monitor alert precision monthly and retune quarterly. Track dismissal reasons systematically to understand what needs fixing. Resist volume expansion that sacrifices accuracy. Implement provider segmentation so the experience adapts to individual engagement patterns. Demonstrate value through feedback loops showing outcomes. Invest in ongoing technology improvements to keep the platform competitive.
Year one success happens because of novelty and initial optimization. Year two success requires continuous improvement and active fatigue management.
The prospective programs still thriving in year three are the ones that treated launch as the beginning of ongoing optimization, not the end of development.
