Key Takeaways:

• The goal of hierarchical condition category (HCC) documentation is to capture a patient’s true clinical picture, including their disease severity and associated risk.
• Stanson’s PINC AI™ Clinical Decision Support (CDS) can help organizations capture HCC codes by implementing alerts to prompt providers to add the necessary codes in the electronic health record (EHR) workflow.
• With 30 actionable HCC alerts, Bon Secours Mercy Health was able to document over 35,000 HCC categories in 2021.

For more on this topic:

• HCC coding is challenging, but we've got you covered. Reach out to PINC AI™ Clinical Decision Support today.
• Join this webinar to hear how North Memorial Health and Blue Cross Blue Shield (BCBS) Minnesota are collaborating to implement an electronic health record (EHR)-embedded point of care hierarchical condition category (HCC) coding improvement solution to drive significant financial impact and ensure optimal services for patients.
  
• Discover how members are achieving great results with PINC AI™ Stanson.

Bon Secours Mercy Health (BSMH), the fifth largest Catholic healthcare ministry in the nation, is doing its part to boost healthcare quality, safety and cost effectiveness. To accomplish this goal, the health system actively pursues new ways to enhance care and improve outcomes for their patients.

As the healthcare industry shifts to value-based care, BSMH is renewing efforts to better their hierarchical condition category (HCC) coding accuracy. HCC coding is a risk adjustment methodology used to estimate a patient's future healthcare costs. For example, in comparison to a patient with no major health problems, a chronically ill patient is more likely to have higher healthcare utilization and costs. As a result, each patient receives a unique "score." Correct coding is critical for accurately predicting future healthcare costs for patients and ensuring the appropriate reimbursement for providers.

Tackling Coding Challenges with Stanson’s PINC AI™ CDS for HCCs

Keeping the importance of accuracy in mind, BSMH set out to improve their electronic health system’s (EHR) design and workflows, as well as raise HCC knowledge and compliance among clinicians. Through a partnership with Stanson Health, a Premier affiliate, BSMH activated 30 HCC alerts that are designed to assist a clinician in identifying whether a new or different HCC code should be considered to optimize diagnosis coding. Using actionable HCC alerts, BSMH was able to document over 35,000 HCC categories in just six months, leading to a significant financial impact.

The Alert Fatigue Dilemma

Success for BSMH wasn’t a straight shot. At first, there was hesitancy to adopt HCC alerts due to the prevalence of alert fatigue in most EHR systems. While HCC coding improves patient care, it may add yet another layer of obligations for busy clinicians. “I came to the table as a skeptic. My initial reaction was that the alerts are too much of an ask on the provider,” said Mark Binstock, Chief Medical Information Officer at BSMH. “But the data was what really convinced me. We are seeing high follow rates of these alerts from providers which is extraordinary. It exceeded all expectations.”

So, how are Stanson’s PINC AI™ HCC alerts beating the odds? It’s simple - the alerts are designed to be actionable and built to limit the provider’s administrative burden. They help the provider add the specific suspected HCC code to the visit diagnosis and/or problem list while in the cognitive workflow of ordering for that patient in the EHR.

HCC Alerts Tailored to Your Needs

The beauty of Stanson’s PINC AI™ HCC CDS is the collaborative implementation approach resulting in alerts that are tailored to a healthcare organization’s EHR system. “Stanson has always been open-minded to my ideas,” said Binstock. “They're not saying it's a black box. It's not take it or leave it and I think that's suited us very well.” Through the Stanson analytics platform, BSMH can track how often the alerts are triggered and the overall performance of the alerts. Alert data insights are then used to determine “follow” rates of the alerts which indicates improved HCC coding capture at the point of care.

BSMH staff are now putting some of the time they used to spend on paperwork and documentation to better use. “I do, in retrospect, regret that I didn't do this sooner,” said Binstock. “Other healthcare organizations should keep an open mind. On the surface, it seems like a tall order throwing in 30 alerts, but the proof is in the pudding.” Clinicians always have the ability to override the alerts if needed. Stanson’s PINC AI™ HCC alerts provide a feasible and effective solution to support healthcare organizations on their value-based care journey, despite the hurdles they may experience in delivering both high-quality and affordable care to their members. It's simply another example of how CDS, when used correctly, can improve efficiency, reduce the rate of costly medical errors, and increase provider and patient satisfaction.