Targeting chronic conditions to improve quality measurement in healthcare

Business Challenge
A Midwest-based managed care organization(MCO) specializing in Medicare and Medicaid wanted to improve quality measures in healthcare for patients with chronic conditions.
The health plan needed a solution that could handle the volume and complexity of HEDIS© dataretrieval and abstraction across multiple third-party providers and electronic health records (EHRs).

Accelerating retrieval and clinical review to improve care
The MCO selected Reveleer’s comprehensive HEDIS solution, which included our AI-powered retrieval and clinical review technology and Reveleer's clinical services team.
Reveleer accelerated the MCO’s medical record retrieval with Reveleer’s multi-channel digital and traditional retrieval methods and automated provider outreach capabilities.
To speed up data processing, Reveleer’s platform leveraged advanced optical character recognition (OCR) and natural language processing (NLP) technologies to guide abstractors to important clinical insights resulting in strategies to improve care for patients managing chronic conditions.
Powering HEDIS© and healthcare quality measurement success through AI
By accelerating retrieval and targeting abstraction with AI, the MCO improved its performance scores for the quality measurement HD2: Managing (Long Term) Chronic Conditions by accelerating retrieval and targeting abstraction with AI. It also achieved a one-point increase in the management of chronic conditions measure, the COA-Pain Assessment measure, and the Transitions of Care and Emergency Department Follow-Ups measures. While simultaneously increasing the speed of retrieval and abstraction, the MCO quickly experienced significant improvement in quality scores.
Next steps
The Midwest-based MCO chose Reveleer's quality improvement solution due to its advanced, AI-powered technology and the flexibility of its platform, which allows it to prioritize care gaps aligned to specific measures. As a HEDIS services partner, Reveleer also empowers the MCO to easily meet HEDIS deadlines annually by processing incredible amounts of data in very little time. Looking forward, the MCO expects to drive increased efficiency and improvement in the quality of care for members with chronic conditions.