HCC Insights
Product Overview
HCC Insights is intended to help a health organization receive the correct payment to provide appropriate levels of care in value-based contracts by improving help ensure that your health system receives the right dollars to provide appropriate levels of care for the population in your value-based payment contract. By ensuring correct coding of the conditions, and the severity of the conditions of the population you will better be able to understand the true health needs of the population and ensure that the payments are adequate and appropriate to care for your patients. The tool helps identify type priorities for improvement on an individual patient and provider/practice level and helps you identify appropriate intervention areas. In-Development
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Features
- High Risk Gap Identifier: Identify patients who had high risk scores last year but currently do not have high scores. This will enable identification of patients who have not yet been in for appointments in the calendar year, to provide necessary preventive care and document risks that are still present.
- Persistent Diagnosis Tracker: Because chronic conditions are sometimes not the primary reason for a visit, they may not show up on a patient’s billing history depending on the accuracy of the coding within a health system. Persistent conditions such as amputations, however, impact a patient and their needed level of care every year and thus identifying when these codes may be necessary due to their past presence can be an important way to improve coding accuracy.
- Code Adequacy Identifier: Identify providers who use a generic code for a condition where precise codes may be more accurate. Compare providers to others in the system, and to system average. Providers who are over-using a generic code may need education on appropriate coding techniques.
Data Sources
- Claims
- EMR
- Risk Model Analyzer (Required Application)
Anticipated Improvements
- Patient risk scores more accurate
- Increased number of patients brought in for preventive or timely care
- Chronic conditions better documented in patient care record
