In MSSP and ACO REACH, ACOs need to operationalize how to have a risk adjustment program, which is difficult to implement and scale without the right people, process, and technology. ACOs, whether existing or new entrants, need prospective risk adjustment tools that enable them to seamlessly and confidently capture risk and manage patient care. By doing so, these ACOs can ensure they meet their value-based care initiatives.
However, with many prospective risk adjustment tools on the market, how can you be sure your organization is in the right hands or that the solution offerings meet the needs of your organization?
ACOs should ask these four questions when evaluating a prospective risk adjustment tool for their organization to ensure value-based care success.
1. Is Your ACO Able to Successfully Access, Aggregate, and Analyze Your Data?
80% of the millions of patient data created every year is unstructured. Unstructured data, which includes clinical notes, scanned documents, images, and other free-form files, is often disorganized and text-heavy, making it difficult to surface key patient details. As a result, clinicians may not have the resources at hand to access, aggregate and analyze this data, meaning they could be missing vital patient information. Beyond this, for many ACOs, patient data is siloed across multiple EHRs, departments, and/or locations, causing health data acquisition and management to be cumbersome, redundant, and costly.
These challenges become obsolete by utilizing solutions that enable your ACO to securely and centrally store and access patient data in real-time. Ideally, teams should be able to easily search, filter, view, and download charts directly anytime, enabling the seamless gathering and aggregating of information needed to surface insights about the patient. Not only would your ACO be better at collaborating across departments and locations, but also clinicians and staff would experience less administrative burden.
2. Will the Pre-Visit Prep Process Work With or Against Your ACO?
Pre-visit planning is becoming a critical step in the delivery of patient care. Clinicians struggle to accurately assess patients due to data overload within the EHR leading to clinical burnout. Pre-visit planning helps by having clinical staff gather and organize the patient’s records prior to the patient’s visit. Unfortunately, current processes for pre-visit planning are cumbersome and time-consuming, requiring administrative staff to manually search through various systems and formats of health data to surface valuable patient insights before the encounter.
To increase the value of annual wellness visits (AWVs) and other scheduled visits, ACOs can utilize technology to surface and extract insights from patient data during pre-visit planning so that more accurate and efficient care delivery can be made based on a patient’s health record. As a result, your clinicians can evaluate the insights, such as suspected conditions, during patient encounters.
3. Will your Clinicians Trust the Insights at the Point-of-Care?
As part of the ACO, clinicians face alert fatigue and have difficulty trusting the alerts in the EHR. Alerts that are false positives can be triggered and create a lack of trust in the insights. Without having an accurate, actionable health profile of their patients, clinicians are limited in knowledge to properly deliver patient care.
By leveraging technology, teams can review and provide evidence within the EHR and push insights directly into the EHR workflow for the patient encounter. Clinicians can trust the actionable insight based on a complete and accurate patient health profile, close diagnosis gap, and evaluate suspected conditions. As a result, clinicians can spend less time on administrative work and more time on patient care.
4. Is Your Documentation and Coding Complete and Accurate Before Claims Submission?
To evaluate if your documentation and coding are complete and accurate, concurrent chart reviews are an activity that ACOs can do to submit accurate claims with supporting evidence. The challenge is that concurrent chart reviews can be arduous, time-consuming, and prone to administrative bottlenecks. Not only does this lead to clinician and administrative burnout, but it also leads to inaccurate risk capture of the population’s disease burden for ACOs.
By enlisting automated workflows, reviewers can quickly assess diagnoses and encounter notes after a patient visit. This will allow them to identify potential diagnoses to add and/or remove and verify documentation. In addition, the right solution should allow reviewer queries to be sent straight into the clinical workflow for validation, all before claims submission. In doing so, providers and health plans can be sure post-visit documentation is complete, and codes are accurate before claims submission while streamlining workflow efficiencies.
Your ACOs Solution Ideal Prospective Risk Adjustment Solution is in Reach
In an alternative payment model, aligning the people, processes, and technology is fundamental in clinical, operational, and financial outcomes. AI is the latest tool to enable ACOs to improve care delivery, reduce costs, and optimize patient outcomes.
Connect with us today and learn how Apixio’s AI-driven prospective risk adjustment solutions can support your ACO.