Increasing efficiency in value-based care through AI
Business challenge
A large risk-bearing health system headquartered in Florida experienced a major shortage of clinical documentation integrity (CDI) professionals. The staff shortage threatened its compliance status as well as accurate payment for the 650,000 lives served under risk-bearing contracts.
The system needed to make more efficient use of scare and costly CDI professionals’ time, and they needed to do so without compromising clinical quality, data accuracy, or physician experience.
Using AI to process data and generate opportunities
The health system worked with Reveleer to design an experience that would use AI to surface high-confidence qualifying conditions for pre-visit review.
First, the Reveleer platform sorted through broad sets of data to identify potential clinical conditions to be addressed. Then, high-confidence insights were sent directly to physicians while lower confidence conditions were sent to CDI professionals for review.
Finally, the resulting clinical insights became available as a visit preview integrated into the EHR directly at the point of care.
Information quality over quantity for optimal use of CDI resources
By combining AI and CDI resources, the health system experienced a significant increase in efficiency, making the best use of highly constrained staff time.
Next steps: Optimizing HCC capture at scale
By combining the AI-powered algorithms with CDI professional experience, the health system was able to improve its provider acceptance rate and increase CDI efficiency. Neither CDIs nor physicians are being overwhelmed with long lists of low-merit possibilities, and care team attention is going to the clinical conditions that are most likely to need active management to support high quality patient outcomes.
“This is about value creation,” said the system's Chief Medical Officer. “What we are getting are better results and, at the same time, we found we were twice as efficient with our CDI Nurse Professional resources.”
Related Resources
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