The exchange of health information is going digital which means great advancements in data management are underway.
Consider for a moment the challenges health plans face with chasing charts using traditional methods i.e., selecting members to retrieve charts on for risk adjustment, audits, and submissions without accounting for provider response probability or incremental value of charts being chased. Deprived of the benefit or capacity to analyze their complete membership, choosing who to target is less than scientific and often built off previous year’s campaigns.
Traditionally, older analytical models focus on identifying drop-off (retrospective) conditions rather than the probability of capturing potential conditions within medical records (prospective). And without insight into provider response probability, the chase lists produced using the old ways do not deliver the best outcomes, are time-consuming, inefficient, error-prone and results in provider abrasion.
The digital age provides a significant improvement to the old methods of Suspect and Risk Adjustment Analytics. With most physicians using EHR and the drive for interoperability, digital connectivity to providers is at an all-time high and growing. Modern, digitally optimized chase intelligence combines experiential provider propensity insights, in-flight analytics, and post-campaign assessments to identify data quality issues and improve outcomes.
Keys to modernizing your chase lists using digital intelligence:
- Begin by assessing your entire membership, to identify suspects to add to your chase list.
- Match your complete list against the rendering care providers to understand who are the most responsive to record requests and preferably fulfill charts electronically and deprioritize those who aren’t responsive.
- Leverage Artificial Intelligence (AI) to assess member encounter data for newly developed conditions that could impact the member’s health risk.
- Aside from the obvious goal of identifying candidates with gaps in care, use this stage to rule out members that may no longer qualify or are deceased and delete immediately from your list.
- Use in-flight results to track members and adjust within campaign who you are chasing. Set up an automated system to notify you when a chase is exceeding the time or cost thresholds set for the project.
- Keep a pulse on your submission process. Make sure all your hard work pays off by ensuring data integrity to mitigate lost risk.
- Post campaign assessment, see how well your modern chase list compares to your traditional process—you will be pleasantly surprised. Most plans see a 10% or greater improvement versus traditional models.