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Customer Stories

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Propelling HCC Coding Accuracy

Key takeaways:

  • UConn Health faced challenges in effectively recapturing Hierarchical Condition Category (HCC) codes and boosting Risk Adjustment Factor (RAF) scores.
  • The health system partnered with PINC Al™ Stanson to integrate their proven risk-adjustment solutions into provider workflows, blending actionable alerts with ongoing provider education efforts.
  • Through this collaboration, UConn Health saw significant improvements in RAF scores, maintaining a 75 percent follow rate and opening doors for further opportunities beyond risk-adjustment coding.

At UConn Health, the pursuit of excellence isn't just a goal—it's a way of life. However, despite existing value-based care (VBC) agreements with payers and joining a new Accountable Care Organization (ACO), the health system encountered challenges in effectively recapturing Hierarchical Condition Category (HCC) codes and boosting aggregate Risk Adjustment Factor (RAF) scores.

Despite diligent efforts through broad initiatives to educate providers on the importance of risk-adjustment coding, the desired impact remained initially elusive. In a recent interview, Khadija Poitras-Rhea, AVP of Population Health at UConn Health, shed light on how a strategic partnership with PINC AI™ Stanson led to significant improvements in HCC coding.

The Q&A below has been edited for length and clarity.

What led UConn Health to explore potential solutions for addressing HCC coding challenges?

We were drawn to PINC AI™ Stanson's proven track record in risk-adjustment solutions. While we had an existing partnership in place, we recognized the opportunity to fully leverage Stanson's expertise to blend actionable alerts with our ongoing provider education efforts. The seamless integration of PINC AI™ Stanson's HCC coding solution into our workflows was particularly appealing.

How has the collaboration with PINC AI™ Stanson complemented UConn Health's ongoing efforts in this area?

PINC AI™ Stanson’s support in integrating their HCC solution into our provider workflows was instrumental. It enhanced our communication efforts and allowed us to drive action and documentation around our education initiatives, fostering improved RAF scores for our populations.

How did you ensure team alignment and support throughout the process of implementing the HCC alerts?

Securing physician leadership support, particularly from primary care, was our initial step. Establishing strong physician-to-physician relationships was key, and PINC AI™ Stanson's physician executives proved invaluable in this regard. We prioritized ensuring that the alerts wouldn't contribute to information overload, emphasizing the importance of sound clinical logic and criteria behind their activation. Our approach involved initially engaging our primary care providers, conducting thorough education sessions on the alerts and their underlying logic. Additionally, leveraging Stanson analytics helped us grasp the potential impact and refine our strategy based on silent data. Physician leadership discussions were instrumental in driving the project forward and garnering provider buy-in, particularly regarding advancing risk-adjustment coding initiatives.

What are providers saying about the effectiveness of the implemented strategies?

The feedback from providers regarding PINC AI™ Stanson’s HCC alerts has been overwhelmingly positive. During the roll out and initial stages, the response was notably quiet, which typically indicates satisfaction. We believe our providers generally find it user-friendly, clinically accurate and not administratively burdensome. They appreciate the ease of use, finding it intuitive to click and add codes to visit diagnoses seamlessly within our existing electronic medical record (EMR) workflow. These early successes have sparked interest among some providers for additional use cases and partnership opportunities beyond risk-adjustment coding, such as exploring NLP-driven suggestions for more appropriate E/M codes based on factors like level of service, medical complexity and time spent.

How did the introduction of this technology contribute to UConn Health's operational improvements?

PINC AI™ Stanson's HCC alerts have been a game changer for us. While it's more retroactive, we're tracking RAF improvement across 2024 and early follow rates indicate a significant lift. Overall, the solution has empowered our team to drive documentation accuracy more effectively.

Have there been any unexpected results from the collaboration?

The partnership has exceeded our expectations in many ways and has been remarkably smooth. While initially anticipating a 40-50 percent follow rate during the rollout, we were pleasantly surprised to achieve a 75 percent follow rate.

What advice would you give to other health systems undertaking similar improvement projects?

My advice for health systems embarking on similar improvement projects is threefold: Firstly, engage your physician leaders from the outset and maintain ongoing communication throughout the process. Provide them with ample opportunities to question the logic behind the initiatives and gain a deep understanding of the clinical criteria involved. Secondly, recognize the importance of securing initial buy-in from physicians, as their support can significantly influence the success of broader population health initiatives. Finally, strive to establish strong partnerships between population health leaders and physicians, as exemplified by successful VBC initiatives, demonstrating the power of collaboration in driving positive outcomes.

Final Thoughts

UConn Health’s journey with PINC AI™ Stanson exemplifies the power of innovative solutions in addressing complex healthcare challenges. By prioritizing physician leadership buy-in, leveraging analytics-driven insights and seamlessly integrating tools into existing workflows, UConn Health witnessed tangible improvements in HCC coding and RAF scores.

As healthcare organizations continue to navigate the evolving landscape of VBC, collaborative efforts and technology-driven solutions will remain integral in driving meaningful change and improving patient outcomes.

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