In a recent webinar, Enhancing pay-provider collaboration: Strategies for improved HCC data quality, IMO Health experts David Arco, Director of Product Management, and Sheena Coke, Senior Product Manager, delved into the challenges payers face with EHR-derived data. They discussed issues like unspecific diagnoses and missed Hierarchical Condition Category (HCC) codes, outlining their downstream impacts on the healthcare system.
In a hurry? Continue scrolling for a few clips and excerpts from this session.
Streamlining workflows and maximizing benefits
“At IMO Health, our integrated terminology solutions streamline EHR workflows, enhancing problem list management and diagnosis capture,” emphasizes Arco. “This capability empowers providers to efficiently document and manage complex conditions, crucial for accurate risk adjustment.”
For payers, this translates to improved data accuracy, enhanced risk stratification, and reduced overpayments, ensuring efficient healthcare cost management and elevated care quality.
Understanding the impact of HCCs on risk adjustment and value-based care
“HCC documentation is vital for optimizing clinical care and managing chronic conditions, directly impacting risk adjustment, reimbursement, and care quality,” explains Coke. “Without solid foundational knowledge of HCCs, health systems risk lower rates of reimbursement, reduced care continuity, and increased management burden of longitudinal health outcomes.”
Importance of payer-provider collaboration
Addressing payer-provider gaps rooted in data silos, interoperability issues, and claims lag times, Coke emphasizes, “Data transparency is crucial. Providers need up-to-date, reliable data, while payers require clinical relevance, code accuracy, specificity, and context.”
Facilitating mutual communication
“[IMO Health’s] focus is on fostering bi-directional communication between payers and providers, ensuring accurate data exchange and supporting holistic health data ecosystems,” says Coke.
IMO Health’s solutions streamline RADV (risk adjustment data validation) audits, which are crucial for validating HCC diagnosis codes and minimizing overpayments.
Enhancing clinical workflows
IMO Health seamlessly integrates with EHRs via API, benefiting payers by improving data accuracy and streamlining reimbursement processes. Our solutions enhance point-of-care decision-making through integrated problem list management and diagnosis capture, ensuring smoother workflows for providers.
“We aim to empower providers with tools that integrate smoothly into their daily practice,” concludes Arco.
DID YOU KNOW?
Every year, CMS updates the CMS-HCC Model with the latest Disease Hierarchies table, and this year, the 2024 version was finalized early in the year. IMO Health has integrated this updated table into our data quality assessment to ensure we capture the most critical health conditions accurately, avoiding any overstatement in the number of HCCs assigned to a person.
With this update, you can expect:
- Improved Accuracy: By using the latest CMS-HCC hierarchy, our assessments now identify the most severe and relevant health conditions more precisely.
- Enhanced Data Quality: Our commitment to using the latest standards means your data is always current and reliable.
- Consistency and Reliability: The updated table is now maintained in our concept database, ensuring seamless yearly updates and consistency in your assessments.
This means you’ll have more confidence in the data you use, leading to better-informed decisions and improved patient outcomes.
