Medicare Advantage programs and capturing hierarchical condition categories is a complex process that AI can help simplify, giving organizations the tools to improve both patient and provider experience.
During a March 24 webinar hosted by Becker's Hospital Review and sponsored by 3M, industry leaders discussed how healthcare organizations can create and drive patient-driven HCC processes to ensure accurate representation of chronic conditions.
The speakers were:
- Dan Engel, chief product owner at 3M Health Information Systems, HCC solutions
- Colleen Deighan, consultant at 3M HIS, outpatient and physician services
Four key takeaways from the webinar:
1. An HCC is a diagnosis code-driven method used to apply cost grouping-based risk adjustment in categorizing clinical condition groups and disease burden scale, Ms. Deighan said. The need for capturing chronic conditions qualifying as an HCC is important for both ambulatory and inpatient providers, and accurate representation is especially key when transitioning to value-based care.
2. The importance of proper HHC capture is increasing as health systems trend away from fee-for-service payments, and instead enter into value-based contracts with payers, according to Ms. Deighan. It is estimated that by 2030, up to 40 percent of patients will participate in a Medicare Advantage risk-based plan.
3. A comprehensive HCC program has to engage all stakeholders to define organizational goals to support the shift "from volume to value," Mr. Engel said. This requires moving away from retrospective analysis to proactive support, and operationalizing data to make continuous improvement. Conversational AI, specifically computer-assisted physician documentation, can help all these efforts by providing real-time feedback from a clinical understanding platform. The technology proactively encourages consistency and accuracy, closes care gaps, improves communication and compliance, and includes personalized nudges for providers.
4. 3M M*Modal HCC Management leverages AI to uncover clinical insights that support appropriate risk adjustment, Mr. Engel explained. The solution prioritizes patients scheduled for a visit based on RAF scores, reviews patient diagnosis and what has been captured in a claim this year, and creates physician notification detailing conditions to be captured this year. This information is integrated into a workflow for both the physician and the outpatient clinical documentation integrity specialists. The solution includes detailed analytics for comprehensive analysis, presenting providers up-to-date visibility into the patient population.
For more information on 3M, click here. To view the full webinar, click here.