It’s no secret that value-based health care programs are changing how health care is delivered. And paid for. By 2030, more than 40 percent of patients will participate with a value-based risk plan.¹ These programs are ultimately designed to provide a model that:
1. Improves patient care
2. Reduces health care costs
3. Advances population health management and outcomes
Health care organizations increasingly use hierarchical condition categories (HCC) risk-adjustment models to calculate risk scores and predict potential health care costs in multiple value-based reimbursement (VBR) programs.
HCC models predict health care spending for a specific patient population. This methodology applies risk adjustment toward a patient’s chronic conditions and major complications, providing a more accurate level of expected health care expenditures across the continuum.
Consistently and accurately monitoring HCCs across multiple care settings can be challenging. For example, based on a 3M aggregate data analysis², nearly 80 percent of patient care occurs in the physician’s office, and many office-based physicians lack the support of qualified coders and clinical documentation specialists to routinely capture the full burden of illness.
With demands on physician time, disparate systems and documentation inconsistencies, it will be increasingly difficult to capture the full patient story and accurately predict the cost of patient care.
80% of patient care occurs in the physician’s office
Developing an effective HCC capture process requires long-term vision, planning and time. Done right, it should provide a path to review the patient’s chronic conditions and measure the organization’s patient population across all care settings. This requires coordination and participation from key stakeholders, including physicians, documentation specialists, administration and others throughout the organization.
With artificial intelligence (AI) enabled technology and consulting expertise, available in the 3M™ M*Modal HCC Management solution, you can build a strong foundation for your program. This comprehensive technology provides a process to improve risk-adjusted documentation and coding through patient prioritization and real time physician nudges at the point of care.
By presenting options, with relevant information at the right time, better decisions can be made without losing the freedom of choice.
Proactive nudges based on past billing and longitudinal record documentation empower physicians to identify the most appropriate ICD-10 codes to efficiently capture the full burden of illness. This reduces rework and minimizes the need for retrospective queries.
Curious what this could do for your organization?
Check out the results from two organizations.
This organization is comprised of eight hospital sites, numerous health centers and physician practices. As an accountable care organization (ACO) participating in the Medicare Shared Savings Program, the organization needed a better process to improve physician documentation and manage its patient population risk adjustment factor (RAF) scores and HCC diagnosis capture rate.
Working with the 3M HCC Management team, this organization implemented a pre-visit clinical documentation integrity (CDI) review to focus on Medicare Advantage patient visits as the primary opportunity for diagnosis assessment. The technology enables physicians to review and sufficiently capture HCC opportunities within their workflow, during the patient encounter.
With non-obtrusive, proactive physician nudges at the point of care this organization achieved:
△ 7% in HCC coding capture
△ 30% in RAF capture per encounter
(results based on seven months data)
This organization had multiple risk-based contracts with a variety of payment models. Without proper management, this could stunt market competitiveness. The organization needed a solution to prioritize service lines within ambulatory office care settings, where the highest volume of reviewed encounters is tied to patients impacted by risk models.
Create an outpatient CDI team across multiple physician practices.
This team is primarily responsible for helping the organization focus on high impact opportunities, which requires analyzing and consolidating large amounts of information across multiple physician practices. To assist in this process, the outpatient CDI team leveraged the 3M HCC Management solution to identify and prioritize top HCC categories.
Increased CDI efficiency
CDI specialists are twice as efficient completing longitudinal chart reviews as compared to simply using the electronic health record (EHR) and spreadsheet reviews.
Enhanced provider engagement
Provider adoption of messages from CDI is 20 percent greater with a nudge vs. receiving an inbox message within the EHR.
An effective HCC solution is more than a physician tool or documentation program. It’s a comprehensive system that integrates expertise across teams to better represent patient care and provide the information needed for managed care programs, all in a single closed-loop process.
Partnering with 3M empowers your organization with the right technology and expertise to create a comprehensive solution. With 3M you can have the confidence that your organization is prepared to successfully navigate the HCC landscape and accurately represent patient care.
2 Figure based on an aggregate data analysis of 3M clients
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