We work with a lot of health systems that are rapidly taking on more and more risk, with various value-based contracts and participation in MSSP, NextGen ACO, CPC+, MACRA, and Medicaid Advantage. When it comes to rolling these contracts out, many of them struggle to identify and execute on the tactical steps needed to support their providers and staff.
One area where we at Clinovations—the division of Advisory Board Consulting that helps with EHR strategy, implementation, and optimization—see our clients experience these challenges is when trying to better identify and capture the chronic conditions impacting their at-risk populations. Accurate documentation and coding is a cornerstone of effective population risk management, as it provides an understanding of the complexities of the patients being served under value-based contracts.
Fortunately, nearly all providers already have a tool that can help them improve risk capture—the EHR.
Three provider-centric benefits of using the EHR to improve risk capture
Providers want to know that the extra work to document Hierarchical Condition Categories (HCCs), and thus capture risk, is going to benefit them from an information availability and care funding prospective. But more importantly, they want to be sure that it will help patients directly by improving quality of care and clinical outcomes. Accurate HCC documentation can help health systems and providers work together to better care for high-risk patients, with care plans and models targeted at specific patient populations.
The most successful HCC capture solutions enable the EHR to present a more holistic story of a patient’s health, and there are three major advantages to investing in an EHR solution to improve accurate HCC capture. The first is the relative ease-of-use for providers, because they will be further leveraging a technology they already use. “The second is scalability across the health system, by which building the right prompts into the EHR allows all physicians to more easily and quickly adopt same workflows to improve risk capture.”. Thirdly, by embedding it into the EHR, there is no lag time in realizing and reporting on the impact of improvements!
HCC capture not just for those taking on risk now
It may seem like risk-based contracts are everywhere these days, but a few of our health system partners haven’t yet taken the plunge. One of our clients decided to implement an EHR-enabled HCC capture solution before taking on risk-based contracts to demonstrate to payers that they understand and can stratify risk, and manage the allocation of resources and services that come along with it.
At whatever point an organization decides to take on contractual risk, accurately documenting the conditions that impact its patients is critical to understanding the complexities of the overall population. Investing in an HCC capture solution is only the first step, but it’s a cost effective and relatively painless place to start.
Understand your starting point
As a starting point, We advise our clients to take a quick, informal survey of where they are in their risk journey, and how their EHR supports them in achieving their risk-management goals. What have been the struggles to date? Are documentation improvement initiatives working? What about problem list management? More often than not, these are issues that can be addressed early once an organization decides to take on risk.
There are a lot of missed opportunities when health systems don’t optimize their EHRs to meet their risk management goals. The EHR is already the tool that each and every clinician in a health system uses to provide care for patients, so shouldn’t the EHR also serve as your population health management tool?
Effectively capturing risk through hierarchical condition categories (HCC) is a significant clinical management and care funding opportunity year over year, and effectively optimizing the EHR to help providers do that is a one-time technical lift that often pales in comparison to the return on investment in the long run.