New healthcare policies, whether federally mandated, payer mandated or internally mandated, are pushing providers toward taking on more financial risk through various value-based reimbursement models — a trend that is driving healthcare leaders to find and implement innovative clinical practices that improve patient health at the population level but are not burdensome for the care team.
In a Jan. 30 webinar sponsored by Nuance Communications and hosted by Becker's Hospital Review, Jeremiah Rothschild, senior director of strategy for Nuance's Provider Solutions Division, discussed how new technology can help align physician strategies, ease the transition to value-based reimbursement models, facilitate physician documentation and improve care coordination.
The transition to risk poses industry challenges
Payers and federal and state governments have issued new policies designed to move the industry toward value-based care and greater price transparency. However, these policies and programs often don't align and can place onerous administrative and reporting requirements on physicians. This can increase physician burnout and place extra burden on the care team, according to Mr. Rothschild.
"With all of the changes focused on revenue integrity and providing care, it's become an alphabet soup of programs — some federally mandated or state mandated or payer mandated and some by the organization — and those programs don't always tie together nicely and it creates a situation where burnout is high for physicians and other members of the entire care team," Mr. Rothschild explained.
Additionally, point-of-service collections, clean and fast billing strategies, accurate care documentation and proper risk adjustment are even more vital to the provider's bottom line as health plans transfer financial risk to provider organizations.
After speaking with numerous provider organizations to understand their unique challenges and pain points, Nuance identified four key opportunities for technology to help physicians in ambulatory care settings navigate the transition to value-based care.
1. Population health analytics. Identifying key intervention opportunities and risk factors prior to a patient visit requires sifting through large volumes of data, which can be tiresome for staff. However, artificial-intelligence-driven technology can quickly sift through past medical records and claims efficiently and accurately to help physicians ensure patients receive appropriate care and plan interventions if necessary.
2. Point-of-care intelligence. In an ambulatory care setting, there isn't always time to address every problem or intervention during one patient appointment. Point-of-care intelligence presents physicians with the most important information at the right time to prioritize intervention and other care strategies.
3. Compliant documentation. Demonstrating quality of care delivery requires that documentation is accurate and complete to support care coordination and risk adjustment. However, the complexity of fulfilling these requirements can negatively affect provider productivity and patient care. Technology that intelligently prompts physicians to facilitate proper documentation — and seamlessly integrates with physicians' workflows — helps ensure patient care is accurately recorded, setting physicians up to receive full reimbursement.
4. Automated intelligence. Providers need "just-in-time" information to make better clinical decisions to optimize patient outcomes and reimbursement, explained Mr. Rothschild. This includes automated chart reviews to analyze medical records to identify any missing information and automated coding assistance. Integrating intelligence technology into physicians' decision-making and documentation processes allows them to focus on clinical needs of the patient versus documentation and coding. Making these processes automated can ensure providers receive the right information at the right time to deliver the right patient care.
Nuance's clinical intervention product
Nuance provides ambulatory care centers with AI-enabled technology to streamline physician workflow, improve care coordination and optimize reimbursement. It can be embedded into EHRs to provide physicians with clinical documentation improvement feedback in real time.
To learn more about the product, listen to the webinar here and view the webinar slides here.
To learn more about Nuance, click here.