The last time you heard from me, I defined two core population health concepts to determine a patient’s overall condition and the expected reimbursement moving forward: the risk adjustment factor (RAF) score and hierarchical condition category (HCC) coding.
A Quick Refresher:
Risk adjustment directly affects provider payment. Depending on what their final score is, which is related to their precise conditions and whether or not they have comorbidities, the cost of healthcare coverage will change. The factors that influence the payments adjust according to the patient’s age, disability, financial status, and diagnoses. To calculate HCC codes, providers use ICD-10 to record changes in health, and each chronic condition is assigned a payment value on the care of a patient with that condition.
But what if we thought less about the actual RAF score and focused more on the action item that comes after it is determined? By asking what we are going to do now that we have the number to make a monetary and personal impact for the patient, we can maximize the information we garner from accurate HCC coding at each appointment.
In our experience, the right approach comes down to having the actionable information conveniently located and organized so that the needs are apparent to prioritize patients. If you can close two care gaps in 15 minutes (or one patient) versus two care gaps in 30 minutes (or two patients), it will prove much more efficient and create a better return on investment for a physician’s limited time. The solutions that yield the greatest results for us are the use of patient facesheets. The printable documents aid providers in closing significant care gaps, providing the critical tools to unify workflows and target outreach from the uncovered information.
The Entire Patient Record at the Point of Care
The patient facesheet, available via a provider’s laptop, tablet, or printed out, has the entire patient record in one place. Their demographic information, their current risk scores, open care gap opportunities, care plan action items, previous diagnoses, current medications, previous lab tests, vaccinations, measure calculations, and others, regardless of their insurance providers. Details gathered in prior appointments are also on the sheet.
The reason we are emphasizing the importance of patient facesheets is how integral they are in helping physicians prioritize their action plans, especially in normal times when a global pandemic does not strain physicians and consume the majority of their time and resources. We analyzed one of our clients’ results with the use of facesheets versus going without from 2017 to 2020. For patients who had a facesheet printed prior to their appointment, the closure rate for HCC conditions was two to three times higher. To illustrate that number, they went from closing three care gaps a day to eight than those without a facesheet.
A Standardized Workflow
With the information in hand on how to best triage and close care gaps efficiently, care managers and other care providers can unify their workflows. When every member of staff acts, documents, and outreaches as a team, there is a better-recorded history with patients that simplify reporting. From there, a care team can create their processes to monitor key performance indicators, identify patients that need additional intervention, pressing care gaps, and social determinants of health issues that can factor in lapses in appointments or their condition status.
For more information on using the right solutions and approaches to maximize time and close care gaps, watch Josh Patten, our Director of Operations’ webinar presentation on the Keys to Creating a Value-Based Culture to Reduce Physician Burnout, available in the Lightbeam Education Center.
Matt Westfall is a Data Scientist at Lightbeam.