We recommended Eco-Scaling™, which would minimize the provider-intrusion factor while increasing labor
efficiencies.
Eco-Scaling™ Improves National Health Plan’s Quality, Revenue Performance
SITUATION
A Health Plan was concerned about enhancing its results from its previous risk adjustment processes – no small consequence considering that the Plan covered thousands of Medicare Advantage members in multiple states. The Health Plan wanted to ensure a positive provider experience relative to its risk adjustment process, with the goal of enhancing its future opportunities to access medical record data. And the plan also required a high coding accuracy rate associated with its chart abstraction process.
SOLUTION
The Health Plan contracted with Outcomes Health. We recommended Eco-Scaling™, which would minimize the provider-intrusion factor while increasing labor efficiencies. Outcomes Health – using registered nurses and certified coders – planned to acquire multiple charts and reuse the data for several audits and analyses.
Outcomes Health provided chart auditing and outreach services for the Health Plan, which delivered much improved results in a short period of time. The Health Plan also utilized Outcomes Health to perform retrospective chart review services for the purposes of determining historical coding deficiencies.
RESULTS
Outcomes Health provided the Health Plan with a full-service, end-to-end solution, including risk adjustment chart prioritization, data acquisition and auditing, HEDIS® medical record review and member outreach service. After Outcomes Health’ work, the Plan reported the following:
- SATISFIED PROVIDER NETWORK: Outcomes Health grouped charts together at providers’ offices, minimizing the intrusion factor. Outcomes Health has been able to review more charts, which has resulted in a higher overall return on the Health Plan’s investment.
- IMPROVED COMPLIANCE RATE: The Health Plan’s quality assurance results derived from Outcomes Health’ oversight activities have greatly improved.
- POSITIVE OVERALL RETURN: The Health Plan has reported an increase in its overall return on investment. The financial benefit has been significant not only by the improvement in incremental HCC abstractions, but also from a more efficient chart chase identification process on the front-end. Outcomes Health now provides a full Eco-Scaling™ solution for the Health Plan including services for payment integrity, health outcomes improvement and health advocacy programs.
HEDIS® Project Improves Rates for Health Plan
SITUATION
A Health Plan in the Midwest relied on a vendor to conduct
clinical chart auditing medical record review for their HEDIS® projects. The Plan experienced poor service and missed deadlines – no small concern considering the Plan covered more than 160,000 members’ lives with its Medicare, Medicaid, and Commercial lines of business. The Healthcare Plan was unable to view data in a timely manner – including chart images, data abstracted, and HEDIS® scoring.
SOLUTION
Outcomes Health stepped in to perform medical record acquisition and clinical chart auditing for their HEDIS® project. The Plan was apprehensive at the beginning, having suffered previously from three years of disappointing work from the previous solutions partner.
RESULTS
Outcomes Health quickly put the Plan’s fears to rest by exceeding timeline expectations early in the project and delivering aggregated results on a regularly scheduled timeline – weekly extracts which was well-received by the Health Plan. More charts were retrieved and abstracted compared to the previous company which contributed to HEDIS® rate improvement. Outcomes Health provided actionable data (reports) to be used for rate improvement activities in the off-HEDIS® season. Effective communication solutions helped guide the process and prepare for the upcoming year. The Health Plan has committed to a multiyear contract with Outcomes Health. “It was a pleasure to work with Outcomes Health,” the health services director said.