High recapture rate improved healthcare performance and patient outcomes
A large network provider group representing nearly 300 provider practices, 800 clinicians with 300,000 patients faced an uphill battle: their health assessments did not accurately align to the conditions of the patients, leading to misdiagnosis and a hierarchical condition category (HCC) recapture rate that was lower than historical performance.
A full year of accumulating medical expenses is required to accurately determine HCC predictions for future healthcare utilization, making the correct assignment of HCCs critically important for Medicare Advantage (MA) plan providers. For example, if a patient receives a diagnosis of diabetes in 2021, the provider must be able to recapture that HCC for risk adjustment, which is coded every year. Because the provider group’s practices were unable to access this level of detail, the group wanted to give them a way to increase their chances of recapturing HCCs.
The group needed a technology platform that could enable participating provider practices to capture data for health assessments, accurately document medical conditions and overcome challenges related to HCC information.
The network provider group chose EvokeSmartVisit (ESV), a module within Evoke360 that can be used at the point of care to document chronic conditions, close gaps and track wellness goals.
This exceptional alternative can be used with or without an EHR, eliminating documentation duplication in multiple platforms. EvokeSmartVisit can be utilized in a provider’s office, in the home or in retail clinics.
EvokeSmartVisit has a built-in telehealth component that allows for the ease of viewing patient documentation while conducting a virtual visit. The telehealth capabilities can also be leveraged without EvokeSmartVisit and integrated into any cloud-based EHR or population health management system
ESV has helped the network provider group’s practices increase their chances of recapturing HCCs, greatly improving their ability to manage patients and ensure proper coding. This has helped the practices improve the quality and care of their patients by:
- Identifying and proactively closing gaps in care
- Revalidating HCC data not originally captured from the patient’s medical record
- Creating transparency in managing utilization for practices
Results documented a 7:1 ROI. ESV enabled the group to achieve 80+% recapture rate, over 90% chronic HCC recapture and quality gap closure.