Increasingly, the level of benefit that patients may receive from their health insurer depends on the acuity of their disease. This is particularly true for beneficiaries of Medicare Advantage plans, the fastest-growing form of Medicare coverage. Precise clinical documentation is a key to accurately reflecting disease acuity and ensuring that patients receive the benefits that they need. Payers also set the ACO’s cost-of-care targets based on patient acuity so precise coding is one of the largest drivers of positive contract performance. Understanding this, the ACO launched a priority project in 2019 to help ambulatory providers increase the precision of their clinical documentation beyond the traditional standard.
The project team - including a primary care provider and experts in coding, data analytics, performance improvement and communications – developed an integrated package of educational tools and custom reports to help providers understand the best techniques and greatest opportunities to increase precision. The package included a short training video, toolkits for both primary care and specialist practices, coding reference cards and reports identifying patients with apparent documentation gaps.
The number of conditions coded increased by 11%The project garnered deep engagement from providers. More than 1,500 viewed the training video, 94 percent of our participants. The project also linked the ACO more closely to specialist practices. The ACO developed coding reference cards for 10 clinical specialties, in close collaboration with clinicians and leaders at Specialty Solutions, an ACO stakeholder.
2019 results were promising. The number of conditions coded increased by 11 percent among the ACO’s Medicare Advantage population. We also saw their average Risk Adjustment Factor (RAF) score increase from .66 to .76, an indicator of improved documentation precision.
More precise documentation benefits patients, care teams and providers alike. Patients gain access to the full range of services available to them. Care team members can better prepare for a patient’s upcoming office visit with deeper knowledge of their condition. And in the value-based care model, providers and practices receive more realistic benchmarks for cost and quality. In 2020, we will continue to collaborate with providers and MaineHealth to further increase documentation precision.