When we set out to create a workflow platform for everything Medical Records Review a few years ago, we had a very good idea of what it should be and do, what its benefits would be and how it would address a number of pain points payers (and providers) have with the MRR process. A vision, if you will.

As another HEDIS season is coming to a close and we see, for example, how the preparation and response to the MRRV, the dreaded audit of the MRR portion of the annual quality review, has changed (among other things), I can’t help but be a little proud. Chaos, disorder and countless hours of pulling records together have been replaced with putting a checkbox next to a few member names and clicking a ‘Generate Audit Package’ button, in this case.

Certainly, the enterprise workflow platform we have created is not exactly what we had in mind at the time. We got a number of things right, we made mistakes (and fixed them), we heard from our customers what they really needed and addressed those needs and continue to do so. What we know with a good amount of certainty today what the key aspects of such a workflow platform are:

  1. Configurable and Flexible – we have realized how important it is to allow our customers to staff and run their projects the way they want to
  2. Comprehensive – the status quo was that health plans had to cobble together a number of people, vendors and technologies to get meaningful results. It felt more like herding cats than managing at times. We took the approach of creating a platform that addresses all MRR needs, from Risk Adjustment for all lines of business to HEDIS to one-off audits, the ability to get every medical record, with built-in functionality supporting everything from provider data verification to built-in RADV readiness
  3. Real-Time Visibility – as we look at real-time dashboards of every aspect of the MRR process, it’s hard to imagine how we ever managed without. The term ‘flying blind’ comes to mind when we think about how little timely information was available in the past.
  4. Provider-Friendly – to our surprise, a little feature called Secure Virtual Print, is a big hit. In retrospect, it’s not surprising since provider abrasion is one of the top concerns and Secure Virtual Print really helps on that front. A lot.
  5. Part of the Big Picture – as important as risk adjustment and HEDIS Hybrid projects are, they are part of a larger, usually member-centric, care cycle. To continuously add value we are making our platform a seamless part care management, provider education and gap closure processes. For example, a care manager can pull up the ‘Member Timeline’ dashboard, which visually shows all review periods where a medical record is available, with encounter dates and many additional data points and the ability to click through to the relevant pages on the record in a matter of seconds.
  6. Reliability, Scalability, Speed & Security – obvious ones, but without these, nothing else really matters

As we continue forward implementing some of those ideas we haven’t gotten to and the many we have come up with since, we will follow these guiding principles. They have served us and our customers well so far.

About The Author

Reveleer is a healthcare software and services company that empowers payers in all lines of business to take control over their risk adjustment and quality improvement programs. The Reveleer platform enables payers to independently execute and manage every aspect of provider outreach, retrieval, coding, abstraction and reporting – all under one single platform. Leveraging its technology, proprietary data sets, and subject matter expertise, Reveleer also assists payers with full record retrieval and review services to support financial performance and improved member outcomes.