Coding InSight helps providers, payers and accountable care organizations (ACOs) better manage patient population risk and improve health outcomes by effectively closing risk adjustment gaps in commercial health exchanges, Medicare Advantage, Medicare Shared Savings and Medicaid programs. Built on the company’s HealthData Engine, Coding InSight uniquely leverages Healthline’s proprietary health taxonomy, natural language processing technology and advanced data analytics to uncover missed or inaccurate codes from unstructured patient data and close those gaps prospectively and retrospectively, all in near real time.
As the healthcare industry moves from fee-for-service to value-based care, risk adjustment is increasingly critical for healthcare organizations. It is used by the Centers for Medicare and Medicaid Services (CMS) and many commercial payer organizations to more accurately predict the health costs of each patient and adjust reimbursement rates accordingly. For example, CMS uses a Hierarchical Condition Category (HCC) risk adjustment model to calculate reimbursement rates for organizations participating in the Medicare Advantage program. However, many diagnoses today are often coded inaccurately or not coded at all in the patient record, negatively impacting risk scoring by clinicians and resulting in inaccurate or unrealized reimbursements. According to one CMAJ study where researchers examined more than 11.5 million patient records, 38.1 percent of patients diagnosed with diabetes were not actually coded for diabetes in their patient records – the presence of diabetes was indicated only by diabetes medications and abnormal blood glucose levels. Those with a coded diagnosis of diabetes were found to have a significantly higher level of care quality than those with un-coded diabetes.
“As much as 80 to 90 percent of today’s health data remains in unstructured formats,” said Dean Stephens, CEO of Healthline. “So much valuable information lies in all this untouched data – we call it the gold in EHRs – and tools that help clinicians extract this critical information, especially for risk adjustment, can have a significant impact on practice efficiency, cost savings and patient outcomes. Healthline’s Coding InSight does just this and has the potential to really transform the way clinicians look at risk adjustment.”
Healthline’s new Coding InSight application leverages the HealthData Engine to aggregate and analyze meaningful information often hidden in unstructured patient data from disparate sources – such as free-text physician notes, patient historical charts and hospital admission notes – and turns that information into actionable insights. By combining these unique data mining capabilities with statistical models and advanced coding rules, Coding InSight enables clinicians to easily identify miscoded or un-coded diagnoses in a patient’s chart that otherwise would have been overlooked. This helps clinicians to improve efficiency, reduce costs and accurately realize reimbursements, while also optimizing risk scoring of patients and facilitating timely interventions for improved outcomes.
Coding InSight will be generally available in summer 2015. Key features include:
- Prospective and Retrospective Coding Optimization – Healthline’s proprietary health taxonomy and advanced natural language processing technology provide clinicians with an automated method of analyzing the vast amounts of data resources, especially unstructured data, to identify missed coding opportunities prospectively before claims submission and retrospectively after claims submission.
- High-Accuracy Risk Scoring – For each opportunity identified, Coding InSight calculates a risk adjustment factor (RAF) score in real time based on the HealthData Engine’s powerful inference technology and sophisticated clinical rules. Clinicians and coders, as a result, are able to more accurately identify their high-risk patients and proactively improve care delivery.
- Analytics and Reporting – Using disparate sources of data, Coding InSight’s comprehensive dashboard delivers real-time, actionable data that empowers healthcare organizations to manage financial impact in the risk adjustment market. Advanced reporting also enables them to maintain program integrity and reduce audit risks.
- Workflow Integration – The Coding InSight application tightly integrates with an organization’s existing EHR and other coding applications, enabling easy workflow integration and improved user productivity.
“Before Village Family Practice began the pilot program with Coding InSight, each of our clinicians manually went through their patients’ charts and mined codes that were either captured inaccurately or missing altogether,” said Dr. Clive Fields, president of Village Family Practice in Houston and co-founder of VillageMD. “This required a lot of time from our clinicians – time that could be better spent seeing patients – and we wanted a solution that would automate this tedious process for us. With Coding InSight, we are already beginning to see significant improvements in practice efficiency, as well as potential cost savings and improvements in care quality.”
Healthline is showcasing the new Coding InSight application and the HealthData Engine at Booth #5075 at the 2015 HIMSS Annual Conference & Exhibition in Chicago, April 12-16, 2015. To see a demo of the product or hear Village Family Practice present about their experiences with the pilot program, visit the Healthline booth.
Healthline provides intelligent health information and technology solutions that help healthcare organizations and everyday people make more informed healthcare decisions, improve outcomes and reduce costs. Powered by the world’s largest health taxonomy and state-of-the-art natural language processing technology, Healthline’s HealthData Engine platform, InSight applications and HealthSearch solutions turn disparate structured and unstructured data into actionable insights. Additionally, the company’s consumer website, Healthline.com, delivers relevant, timely health information, news and resources to help consumers manage their health. More than 25 million consumers per month and some of healthcare’s largest brands, including AARP, Aetna, UnitedHealth Group, Microsoft, IBM, GE and Elsevier, currently use Healthline’s products. For more information, please visit corp.healthline.com and http://www.healthline.com, or follow @HealthlineCorp and @Healthline on Twitter.