Patients records with new HCCs identified and accepted by the provider
New HCCs accepted per patient reviewed
Increase per member per month through RAF capture
Return on investment (ROI)
Provider enterprises are rapidly moving to risk based reimbursement models. Medicare Advantage is now the fastest growing segment of the payer market and alternative payment models continue to gain momentum across both commercial and federal payers. The rapid rise in Medicare Advantage and other alternative payment models makes accurate and timely diagnosis critical for successful care delivery. Studies show that early detection can significantly reduce total cost of care while improving the overall quality of life.
IKS’ Clinical Chart Review solution helps optimize your Medicare risk adjustment program by enabling early diagnosis capture and quality of care outcomes. Each longitudinal patient record is reviewed by trained diagnosticians. All inferred and suspect diagnosis, supported by clinical evidence is presented to providers at the point of care making it easier for them to act. Detailed analytics, combined with bi-directional feedback make this a robust and compliant program to effectively enable proactive care delivery.
Based on various risk arrangements with payers and prioritized based on pre-defined variables
All relevant data sources including Outpatient Consult Notes, Discharge Summaries, Claims data, Pharmacy data, Lab & Imaging Results are reviewed
IKS clinicians identify chronic diseases, which may have been treated, inferred or embedded in the medical record, but not fully documented in the chart.
Physician reviews the recommendations & assesses the patient for inferred diagnosis, as appropriate. Non-validated HCC recommendations are reviewed for bi-directional feedback.
Through early diagnosis of chronic conditions, improving the quality of life for patients and reducing the total cost of care for enterprises.