Pandemics & EHR:
Pandemics have always been a wake-up call to humanity that compels us to rethink the healthcare framework every once in a while, while technological leverage to healthcare has never been so advanced and groundbreaking before. Only a decade of healthcare data can bring much more deep insights that overall health research would not be able to as per Vinod Khosla.
It has been apparent that chronic disease be it type-2 diabetes, Asthma or respiratory or pulmonary illness makes people more vulnerable to succumb to viral outbreaks with compromised and weak immunity. Historical data can save the day for such people who can go from taking an individual medical history to hereditary and genetic causes.
Historical Data & Patient Analysis:
It is evident that the current pandemic will change the way we look at Electronic Health Records. This situation would demand a huge surge in collecting healthcare data globally of a 7+ billion populous to prevent another such event where technology can play a major role. Helping healthcare organizations for a long time making EHR’s more efficient to read handwritten and digital prescriptions as well as making use of that data for analytics and insights.
Platform: Innovative Quality Mgmt. & Document Understanding with HEDIS:
One of our clients came forward to aggregate the much-scattered pieces of information while delivering a platform that utilizes HEDIS Audit Management. This platform is a quality measurement and reporting ICD Engine targeted towards health plans to allow the –
- Cost reduction of compliance with HEDIS Audit requirement by streamlining and automating the entire audit process, ultimately reducing time to audit each patient.
- Achieving a higher HEDIS star rating score which results in higher bonuses and capitation.
- Implementing robust pay for performance programs with providers by closing gaps in care and thereby reducing overall patient care costs.
The platform has been developed for obtaining optimum financial performance and lowering the compliance risk; health plan distributors and medical practice groups require an automated solution where the risk adjustment can be more accurate.
We together built this ICD engine which deploys the precise word matching in the market. This engine helps in finding the words that confirm the presence of risk adjustable ICD in medical records. During the first scan, the engine highlights all the ICD matches in a fraction of seconds, thereby finding more HCCs. This increases coding speed and improves overall coding accuracy. This word matching is up to 98.2% accurate.
Here are some of the benefits that the ICD engine is bringing to the risk adjustment coding efforts –
Delivers higher HCC coding accuracy
This precise word matching Artificial Intelligence consistently helps coders confirm over 96% of the documented HCCs. This means improved financial performance while lowering RADV audit and other compliance risks.
Identifies all the documented codes
The engine finds all documented codes so, it helps in coding for any government program including every state Medicaid program. Also, all the documented codes can be filtered.
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Emphasize only documented codes
Precise word matching AI highlights the documented diagnosis and gives coders the correct and specific code to confirm.
Much improved accuracy
The engine is tuned for negative terms in medical records. It filters a much higher percentage of false positives without creating false negatives.
Major Takeaways:
- As value-based care reimbursement protocols continue to become a mainstay in the healthcare industry. More payers are bringing HEDIS measures to the forefront.
- Healthcare plans are transforming from a traditional fee-for-service model to a population health model. The HEDIS tool helps in aligning all payers in the healthcare system. It focuses on a population’s overall health and long term well-being.
- The quality measures close the gaps in care and decrease the use of costly care through preventive services. With the switch to ICD – 10 codes, all paperwork will also enable the new diagnostic coding set to both to receive a reimbursement and meet quality measures in the new value-based care payment environment.
- The quality measures expand preventive services including immunizations, pap, mammogram screenings as well as hypertension, and cholesterol management.
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Conclusion:
It is vital for health payers and claims managers to focus on the population’s health management and patient engagement. To succeed in a value-based care environment, both factors are crucial. This ultimately results in patient satisfaction and an efficient ecosystem to predict and prevent future pandemics leading humanity to a healthier and immune future.
