Your contract with risk adjustment vendors looked great when you signed it. The first few months went smoothly. But somewhere along the way, things started going wrong. Not catastrophically wrong. Just gradually, subtly wrong in ways that are hard to pinpoint.
Here are the warning signs that your vendor relationship is failing, what each one means, and whether you can fix it or need to start planning your exit.
Warning Sign #1: You’re Getting Metrics Without Context
Your vendor sends monthly reports. Charts coded: 3,247. HCCs identified: 8,912. Query response rate: 67%. The numbers look fine on the surface.
But you have questions. Why did chart volume drop 15% from last month? Why is the query response rate declining? Which providers or conditions are driving the trends?
You email your account manager. They say they’ll look into it. A week later, you get a generic response that doesn’t actually answer your questions. Or worse, they give you more aggregate numbers instead of the analysis you requested.
This means your vendor is treating you like an account, not a partner. They’re checking boxes on their reporting requirements without actually helping you understand your performance.
Can you fix it? Sometimes. Escalate to vendor leadership and explain that you need analytical support, not just data dumps. If they respond by assigning someone who actually digs into your data and provides insights, the relationship might be salvageable. If they keep delivering surface-level reports, start planning your exit. You’re paying for expertise you’re not getting.
Warning Sign #2: The Same Problems Keep Recurring
Six months ago, you flagged that your vendor’s coders weren’t properly documenting MEAT criteria for CHF. They acknowledged the issue and said they’d retrain their team.
Last month, your internal QA found the exact same problem. Different charts, same error pattern. You flag it again. They apologize and promise to address it.
This month, your internal QA finds it again.
When the same quality issues recur despite repeated escalation, it means the vendor either can’t fix the problem or won’t invest the resources to fix it properly. Either way, you’ve got a vendor who’s not capable of delivering what you need.
Can you fix it? Unlikely. Systematic quality problems that persist despite escalation indicate fundamental issues with the vendor’s training, QA processes, or workforce capabilities. You can demand corrective action plans with specific timelines and penalties for non-compliance, but vendors who haven’t fixed problems after multiple escalations probably can’t or won’t fix them. Start evaluating alternatives.
Warning Sign #3: Vendor Turnover Is Affecting Your Results
Your original account manager was great. She understood your organization. She anticipated problems. Then she left. Her replacement is fine but doesn’t have the context.
Your dedicated coding team had three coders who really understood your documentation patterns. Two of them left in the past four months. The new coders are making rookie mistakes.
Your original implementation consultant was excellent. He’s now managing 15 accounts instead of 5 and doesn’t have time for you anymore.
High vendor-side turnover directly affects your results, especially with risk adjustment where organizational knowledge matters. When the vendor can’t retain the staff working on your account, you’re constantly training new people at your expense.
Can you fix it? Not really. You can’t control vendor HR decisions or compensation. You can negotiate dedicated teams with contractual turnover protections (“if more than two of our assigned coders leave within 12 months, we get a discount or can exit the contract”), but that only works if you include it upfront. If you’re already experiencing turnover problems, your leverage is limited.
Warning Sign #4: Scope Creep Is Making Everything More Expensive
When you signed the contract, the vendor quoted you $40 per chart. That seemed reasonable. But over time, more and more work falls outside the base scope.
Query management costs extra. Revision requests cost extra. Rush projects cost extra. Training new providers costs extra. Generating custom reports costs extra. Attending your internal meetings costs extra.
Your blended cost per chart is now $58, and you didn’t budget for that.
This means either the vendor intentionally structured pricing to look competitive while hiding costs in overages, or they’re nickel-and-diming you for things that should’ve been included. Either way, you’re overpaying.
Can you fix it? Maybe. Negotiate a scope clarification and fee schedule with specific inclusions. “Base price includes X queries per chart, Y revisions per month, Z hours of meeting time.” Get commitments in writing. If the vendor won’t put reasonable inclusions in writing, they’re going to keep charging you for everything. That’s your answer about whether the relationship is fixable.
Warning Sign #5: Your Vendor Is Defensive Instead of Collaborative
You raise a concern about accuracy rates. Instead of investigating, your vendor explains why the metric doesn’t reflect their true performance. You question a coding decision. Instead of walking through their logic, they cite their coders’ credentials and suggest you don’t understand coding standards.
When vendors respond to feedback with defensiveness rather than collaboration, the relationship is broken. Good vendor relationships involve honest conversations about what’s working and what’s not. Vendors who can’t accept critical feedback aren’t partners.
Can you fix it? Rarely. Defensiveness is a cultural issue, not a process issue. You can try escalating to different stakeholders within the vendor organization to find someone who’s collaborative. If the defensiveness is pervasive throughout the organization, you can’t fix it. Defensive vendors don’t improve because they don’t believe they need to.
The Decision Framework
When you spot these warning signs, you have three options: fix the relationship, manage around the problems, or exit the contract.
Fix the relationship: Have direct conversations with vendor leadership. Explain specific problems. Give them clear timelines to demonstrate improvement. If they respond constructively and actually fix things, the relationship might be salvageable.
Manage around the problems: If the problems are annoying but not catastrophic and switching costs are high, you might accept a mediocre vendor relationship and build internal workarounds. This isn’t ideal, but it’s sometimes the pragmatic choice.
Exit the contract: If problems are systematic, recurring despite escalation, or the vendor is fundamentally incapable of meeting your needs, start planning your exit. Review your contract termination provisions. Begin vendor evaluation while you’re still under contract so you can transition smoothly.
Don’t stay in a failing vendor relationship because switching is hard. Switching is hard. Staying with a bad vendor for three years is harder. The sooner you recognize warning signs and take action, the less damage you’ll absorb.