Making the Case for a New Approach to Managing Quality and Risk: Intelligence Automation in the Ambulatory Care Setting

Transcription

1 Making the Case for a New Approach to Managing Quality and Risk: Intelligence Automation in the Ambulatory Care Setting Tuesday, January 30, :00-1:00 PM CT Jeremiah M. Rothschild, PMP Sr. Director of Strategy, Provider Solutions Nuance Healthcare 2016 Nuance Communications, Inc. All rights reserved.

2 Topics Clinical documentation and risk adjustment practices in the ambulatory setting Why organization's can't simply transplant hospital CDI into ambulatory facilities How automated intelligence can improve clinical documentation and physician satisfaction at the point of care 2016 Nuance Communications, Inc. All rights reserved. 2

3 Industry Challenges Why the time is right for new approaches Health plans are transferring financial risk of member care to provider organizations are you ready? Historical financial priorities Pre-service financial clearance Point-of-service collection Clean & fast bills Managing denials Revenue integrity challenges Volume vs value MACRA/MIPs/APMs HCC risk scoring Medical Necessity/authorization Quality ratings Achieving optimal care & reimbursement Close gaps in care in realtime Properly document and code each encounter to support quality and risk adjustment 2016 Nuance Communications, Inc. All rights reserved. 3

4 Key Capabilities Needed Solving the unique challenges in ambulatory care 30% Identifying key intervention opportunities and risk factors requires intelligently sifting through large volumes of data There isn t always enough time to address every problem or interventional opportunity in one visit. Most physicians do not know what to document for proper HCC coding and reimbursement Population health analytics AI-driven technology quickly analyzes volumes of historical medical records and claims efficiently and accurately Point of care intelligence Presents the right advice at the right time to help physicians prioritize which problems to address during the visit and what may require additional attention through proactive follow up Compliant documentation Intelligently prompt physicians in-workflow to facilitate compliant documentation and coding practices 2017 Nuance Communications, Inc. All rights reserved. 4

5 Automated Intelligence Providers need just in time information from healthcare stakeholders to enable physicians to make better clinical decisions and optimize reimbursement 72% Nuance today works in some capacity with the majority of providers in the US 400,000+ Nuance s Dragon product line is used by thousands of physicians Nuance delivers actionable content into existing workflow 2016 Nuance Communications, Inc. All rights reserved. 5

6 Nuance Quality and Risk Adjustment Intelligent solutions for wellness and chronic disease management Medical records & claims Patients CDI Team Higher quality care Patient identification & scheduling Providers Population health specialists Care coordinators Coding Appropriate Quality reimbursement & proper risk adjustment Changing the way patient information is analyzed, presented and managed to address the unique challenges of quality care, coding and risk adjustment for managed care populations 2017 Nuance Communications, Inc. All rights reserved. 6

7 How it works Intelligence to analyze data, prioritize workflow & document care Upcoming appointment list is triggered by the daily scheduling feed Automated chart reviews analyze claims and medical records to find missed HCC codes Prioritized opportunity list is prepared for the provider Advice is prioritized and presented to the provider in the EMR to document all the information required for proper HCC coding Automated coding assistance makes it easy for providers to assign codes appropriately Reporting analytics provides statistics to the care team to identify areas for improvement, search for additional opportunity or initiate patient outreach Automatically discover and prompt care team members to schedule targeted visits to address gaps in care 2017 Nuance Communications, Inc. All rights reserved. 7

8 A platform for delivering intelligent interventions to providers A platform for delivering actionable interventions to providers Risk Adjustment & Analytics Suspecting Recapture New Opportunities Coding Workspace Computer-Assisted Quality Alerts Quality Measure Alerts ICD-10 Specificity Clinical and Administrative Interventions Safety & Compliance Point of Decision Messaging Point of Care Decision Support 2016 Nuance Communications, Inc. All rights reserved. 8

9 Results Large Integrated Health System Successful outcomes using population health analytics Productivity improvement Administrative savings Improved reimbursement Return on investment 400 % $10 M $3 M 26:1 Automated chart review helps improve efficiency and scale Efficiency and accuracy saves time and $$ Increased cost savings and revenue impact Resulting from better patient identification and documentation We strive to achieve the highest level of quality. As our member population grows, we need an advanced coding solution to help improve our productivity so we can support increasing workloads while still maintaining our high quality standards. This application will help us effectively identify uncoded or miscoded opportunities with more accuracy and efficiency. Vice president of risk and revenue management 2016 Nuance Communications, Inc. All rights reserved. 9

10 Contact Jeremiah Rothschild, PMP Senior Director of Strategy Nuance Communications For Account and Sales Questions 2016 Nuance Communications, Inc. All rights reserved.