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How Riverside Health is Redefining Their HCC Coding Initiatives

Key Takeaways:

  • In order to be successful in value-based care (VBC)1, healthcare organizations should focus on successful capture of Hierarchical Condition Category (HCC) codes.
  • Riverside Health System turned to PINC AI™ Stanson to provide automated HCC coding guidance to providers at the point of care for assistance with accurate and appropriate HCC diagnosis capture.
  • As a result, Riverside has been able to capture and appropriately document 8,586 HCC codes in the first 6 months of 2022.

“Care for others as we care for those we love.” This motto defines Riverside Health System in its entirety. It’s a mission statement that staff at the Virginia-based health system always strive to maintain. Over the past few years, this adage has gained even more significance as Riverside began the transition from a fee-for-service system to a value-based care (VBC) model1. VBC is more than simply a trendy healthcare catchphrase. Under a VBC model, providers are rewarded based on patient outcomes and experiences, rather than the number of services delivered.

Care at Riverside Health System has always been centered around patients.

Healthcare organizations should adopt a patient-first philosophy if they want to enhance outcomes, patient experience and quality of care. However, in order to be successful in VBC, healthcare organizations also need to focus on successful capture of hierarchical condition category (HCC) codes. Accurate documentation and reporting of a patient’s severity of disease enables health systems to receive the appropriate payment amounts they require to close care gaps. This often leads to better patient outcomes and ultimately VBC success for the health system.

HCC coding was an area that Riverside was looking to improve on in order to drive better patient outcomes. “Virginia, compared to some other states, has shown fairly good healthcare value, so I think we’ve lagged behind the so-called value-based approach to healthcare and there is still a lot of fee-for-service,” said Dr. Charles Frazier, Senior Vice President and Chief Medical Information and Innovation Officer at Riverside Health System. “But as we have started getting more into risk-based contracts and more value-based healthcare, we are now looking at ways to try to improve our coding to more accurately document the complexity of our patients.” To achieve this goal, Riverside sought out new technology to help fuel better and smarter ways of delivering patient care.

Value-Based Care Brings HCC Coding to the Forefront

Riverside turned to Stanson Health, a PINC AI solution, for an integrated solution to provide clinical decision support (CDS) in the electronic health record (EHR) environment. PINC AI™ Stanson HCC alerts provide automated and simplified HCC coding guidance to providers at the point of care for assistance with accurate and appropriate HCC diagnosis capture. At the initial go-live, Riverside took a measured approach and only activated 11 HCC alerts for providers. It wasn’t long before they received a collective thumbs up from providers and quickly implemented significantly more HCC alerts. “We had planned on waiting about a month to six weeks before adding any additional alerts,” said Dr. Frazier. “But we were hitting 40 percent response rates on these alerts, which is high, and I didn’t receive any complaints from providers.”

An appealing component of PINC AI™ Stanson’s HCC CDS lies in its collaborative implementation approach, which produces alerts that are customized to the EHR system of a healthcare organization. “We made some changes and that was another nice thing about working with Stanson. If something works better in your health system or in your environment, then you can go in there and change it,” said Dr. Frazier.

Clinicians also have the ability to override the PINC AI™ Stanson alerts if needed. Plus, the Riverside team can monitor and optimize their CDS program, tracking provider engagement, quality and financial reimbursement improvements as well. As a result, Riverside has been able to capture and appropriately document 8,586 HCC codes in the first six months of 2022. The high response rate from these alerts attest to the strong provider adoption at Riverside. As VBC becomes more widespread, providers are increasingly more motivated to embrace accurate documentation, and PINC AI™ Stanson HCC CDS makes the historically complicated process simpler. This gives providers a valuable resource to help keep patients healthy, not only during visits but throughout every stage of their treatment.

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About the Author

Ryan M. Nellis

Vice President & General Manager, Stanson Health

Ryan leads a team of clinicians, engineers and data science experts who work together to deliver AI-infused solutions to improve patient care and health costs via a growing client network of over 650 hospitals and 400,000 physicians.

Mr. Nellis is a growth-oriented leader who delivers business value in investor/venture and PE-backed, high-growth, public and private companies. He has developed and executed strategies in the health analytics and real-time clinical decision support solution markets – from both the provider and payer perspectives.