ThedaCare’s Path to Smarter HCC Coding Through AI and Clinician Engagement

Key Takeaways

• As ThedaCare expanded its value-based care efforts, the organization, like many health systems, faced challenges in consistently capturing patient complexity, managing documentation workflows and supporting clinicians already balancing significant administrative demands.
• In early 2023, ThedaCare partnered with Premier’s Stanson Health to implement an advanced, AI-enabled coding solution that surfaces real-time documentation advisories.
• As a result, coding accuracy improved across primary care and key specialties, clinician engagement increased and ThedaCare gained a clearer view of population risk—a strategic asset for better care, planning and outcomes.

As a regional health system serving northeast and central Wisconsin, ThedaCare is deeply invested in delivering high-quality, cost-effective care. Its accountable care organization (ACO) supports more than 150,000 attributed lives across 11 contracts, including five with both upside and downside risk. But as the organization expanded its value-based care efforts, it faced a critical challenge: accurately capturing the clinical complexity of its patient population to better support proactive care, risk adjustment and financial planning.

Despite dedicated efforts in clinical quality and care coordination, providers were grappling with administrative burden and alert fatigue. Existing tools failed to bridge the gap between frontline workflows and the need for precise documentation. ThedaCare needed a smarter, more integrated solution and a partner to help deliver it.

A Purposeful Partnership with Premier’s Stanson Health

In early 2023, ThedaCare began working with Premier’s Stanson Health to improve its Hierarchical Condition Categories (HCC) coding processes. The partnership focused on deploying Premier’s AI-powered coding optimization solution, a tool designed to identify documentation gaps and surface real-time best practice advisories (BPAs) within the electronic health record (EHR). These BPAs helped clinicians address uncaptured, under-documented or over-documented chronic conditions that impact patient risk scores, all within their existing workflow.

Rather than introducing a static system, the solution offered adaptive intelligence. It analyzed clinical documentation in real-time, recommended HCC codes based on chart content and aligned with clinical decision-making without creating extra work for providers. Integration with ThedaCare’s EHR enabled the organization to begin with a phased rollout across payer contracts before expanding further.

Premier partnered with ThedaCare to refine the tool’s logic, reduce alert fatigue and respond to clinician feedback throughout implementation. “They weren’t just giving us a solution off the shelf,” said Dr. Mira Iliescu-Levine, Chief Medical Officer of Network Development and Innovation at ThedaCare. “They were refining it with us in real-time.”

Building Trust and Engagement at the Front Lines

Even with a strong technological foundation, ThedaCare recognized that successful adoption would require clinician engagement and education.

“Physicians told us, ‘It’s another alert, another button I have to click,’” said Dr. Iliescu-Levine. “We had to show them how it helps, not just with appropriate coding, but with patient care.”

ThedaCare formed a multidisciplinary task force made up of primary care and specialty physicians, coders, nurse documentation specialists and quality leaders. Together, they audited workflows, identified common documentation gaps, and collaborated with Premier to adjust the tool’s logic. At the same time, ThedaCare launched a robust education program, distributing short tip sheets for common conditions, holding interactive training sessions and assigning physician champions to lead code validation efforts.

“We realized that just sending PowerPoints or laminated cheat sheets wasn’t going to work,” said Dr. Iliescu-Levine. “We needed to listen to our clinicians, answer their questions and make changes based on their feedback.”

Specialists also became more engaged in the process. While primary care remained the foundation for chronic condition coding, specialists contributed by capturing subtler, diagnosis-specific codes that might otherwise have gone unrecognized. To support this, ThedaCare began holding joint training sessions for specialists and primary care teams, encouraging collaboration and shared accountability.

Real-World Results Across the System

As adoption grew, ThedaCare began to see measurable results. Appropriate code capture improved significantly across internal medicine, family practice and several specialties, especially cardiology and endoscopy. The alerts helped clinicians better stratify clinic visits, prioritize high-risk patients and coordinate care more efficiently.

“We used HCC scores to identify patients with diabetes, CHF or CKD who had low risk scores but high actual complexity,” said Dr. Iliescu-Levine. “We brought them in earlier in the year to make sure we weren’t missing anything clinically.”

The change in mindset was just as important as the metrics. “Literally, coding became a friend rather than a foe,” said Dr. Iliescu-Levine. “We realized it could help us forecast care, schedule smarter and actually improve clinical outcomes.”

Premier’s responsive support, combined with ThedaCare’s commitment to continuous education and cross-functional collaboration, turned what was once a source of frustration into a strategic asset. Coding accuracy improved, clinician engagement grew and the organization gained a more accurate view of patient risk to support its financial and care planning goals.

What’s Next: Expanding the Use of AI in Population Health

Looking ahead, ThedaCare plans to expand its use of Premier’s HCC coding solutions to cover additional contracts and patient populations, including younger and commercially insured groups. It’s also enhancing its documentation review teams and building out data integration capabilities to further refine risk stratification models.

“We’re moving from acute care to chronic care, and from chronic care to wellness,” said Dr. Iliescu-Levine. “That means using every tool we have, AI, human intelligence and community partnerships, to deliver the best possible outcomes.”

By integrating advanced AI with frontline clinician expertise and a culture of shared learning, ThedaCare is building a smarter, more sustainable approach to population health, one that’s rooted in both data and humanity.

For more on this topic:

• Learn about what a partnership with Premier's Stanson Health can do for your healthcare organization.

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