Indiana Health System Boosts Bottom Line by $7 Million with HCC Alerts

With a simple change, one health system boosted its bottom line by more than $7 million. What was that change?

Implementing actionable Hierarchical Condition Category (HCC) alerts in their electronic health record (EHR).

Small Changes, Major Results

For much of its history, Community Health Network (CHN) – a non-profit health system with more than 200 sites of care and affiliates throughout central Indiana – dealt with risk scores below the national average. But as the healthcare landscape moved to risk-based contracts, CHN shifted its focus to HCC training and EHR workflows.

In 2019, CHN’s leaders implemented actionable HCCs. By partnering with Premier, they developed goals that included:

• Streamlining the process of recapturing known diagnoses
• Identifying and documenting suspect conditions, and
• Uncovering undocumented conditions and verifying them.

They began with 10 codes covering three categories centered around diabetes and morbid obesity. While CHN wanted to start small, they strategically selected categories that would have a sizable impact.

In 2020, this shift resulted in an impact of nearly $5 million on the baseline spend calculation for their Medicare Advantage and Next Generation ACO patients.

And in the first quarter of 2021, CHN expanded its coding efforts to encompass 33 alerts, tallying more than $2 million in impact over three months.

The improved accuracy and focus on HCC coding have enabled CHN to optimize success in value-based care models and increased their financial outcomes.

Three Hallmarks of Effective HCC Alerts

CHN’s success demonstrates how actionable HCC alerts can benefit an organization while streamlining work for providers. Actionable HCC alerts are:

• Automatic. Alerts occur in real time during encounters and are provided where and when they will be most valuable.
• Effortless. Providers aren’t forced to move around the EHR needlessly; alerts are embedded into the current workflow.
• Efficient. Alerts are based on chart data and are only generated when there’s a suggestion that may help the provider improve the accuracy of coding.

How you code in 2021 will influence future reimbursement.

Check out the on-demand webinar or read the full story of Community Health Network’s success with actionable HCC alerts, and discover how they can work for you too.