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Transforming HCC Coding with Artificial Intelligence: How PINC AI™ Stanson Streamlined Processes and Improved Patient Care at Community Health Network

Key takeaways:

  • Community Health Network (CHN) recognized the potential value in unstructured data within progress notes for coding accuracy but faced challenges in efficiently extracting and utilizing this information, leading to missed coding opportunities and workflow inefficiencies.
  • By upgrading to PINC AI™ Stanson's CodingGuide solution, CHN unlocked the full potential of their clinical documentation. The AI-driven platform intelligently analyzed electronic health records (EHR) and clinical notes in real-time, providing accurate and relevant coding suggestions based on the latest clinical information.
  • The upgrade not only significantly improved coding accuracy and follow rates but also increased provider satisfaction by reducing alert fatigue and enhancing decision-making. Providers were able to trust and adopt the system's recommendations, leading to smoother workflows and improved patient care outcomes.

Since its inception, Community Health Network (CHN) - a nonprofit health system with more than 200 sites of care and affiliates throughout central Indiana - has consistently pursued excellence. In an effort to enhance Hierarchical Condition Category (HCC) coding documentation accuracy and provider efficiency, CHN embarked on a transformative journey through a partnership with PINC AI™ Stanson.

With a history of collaboration grounded in mutual trust and shared goals, CHN and PINC AI™ Stanson have consistently pushed the boundaries of what is achievable in healthcare delivery. When the opportunity arose for CHN to upgrade to PINC AI™ Stanson's CodingGuide solution, it was an easy decision for the health system. "We've worked with Stanson for many years, and I can honestly say that as a technology company, it's very easy to implement the tools and upgrade, especially as you're upgrading your electronic medical record (EMR)," said Dr. Patrick McGill, Chief Transformation Officer at Community Health Network.

The integration of PINC AI™ Stanson's CodingGuide marked a significant shift in CHN’s clinical documentation strategies. "We decided to upgrade to CodingGuide for a number of reasons. One of which was the enhanced ability to review notes and extract more information. Some of the unstructured data within the progress notes is very valuable for coding and enhancing the coding workflow,” said Dr. McGill. “While we had great adoption with our previous tools, we knew that we were missing out on important content within the notes itself. So, we were very excited to be an early adopter of CodingGuide and really leverage the information that was going untapped but significantly contributes to coding success."

Dr. Patrick McGill, Chief Transformation Officer at Community Health Network

Embracing Revalidation for Accuracy

PINC AI™ Stanson's CodingGuide leverages AI-enabled clinical decision support (CDS) to simplify complex HCC coding. This cloud-based solution recognizes that clinical conditions evolve, patients change and diseases progress or improve year over year. CodingGuide introduces a cutting-edge revalidation tool that meticulously examines electronic health records (EHR) and clinical notes, ensuring that HCC codes accurately reflect the current state of a patient's health.

While traditional HCC solutions often rely on recapturing the code used during last year’s visit, PINC AI™ Stanson's CodingGuide with revalidation evaluates the patient’s latest clinical information before suggesting the appropriate code to providers. This enables CHN providers to ensure that diagnoses are relevant and reflective of the patient's current condition.

“We all know that patients are complex, and their clinical conditions change frequently. So, I think through the revalidation process, it really works to reduce the noise and present the codes that are most pertinent at the time, representing the patient's condition,” said Dr. McGill.

Dr. Patrick McGill, Chief Transformation Officer at Community Health Network

Tangible Outcomes of Transformation

This approach not only improved clinical documentation accuracy but also built trust among providers, who no longer felt overwhelmed with irrelevant alerts. Instead, they embraced PINC AI™ Stanson's CodingGuide recommendations, leading to higher follow rates and better decision-making.

"Community Health Network has observed tremendous improvements since implementing CodingGuide. We've seen higher follow rates, resulting in less fatigue for clinicians. We've seen improved accuracy, leading to better coding outcomes and results. With the upgrade to CodingGuide from January 2023 to January 2024, for a subset of the Stanson CodingGuide alerts, by switching to the new version, it resulted in a 22 times improvement in follow rates due to improved accuracy and logic," said Dr. McGill.

The success didn't stop there. One of the standout achievements was the ability for PINC AI™ Stanson CodingGuide to capture diagnoses mentioned solely in notes, such as amputations. Previously overlooked, these critical details are now being incorporated into patient records, due to the advanced capabilities of PINC AI™ Stanson's CodingGuide.

The transformation was evident, with providers experiencing newfound efficiency in their workflow, thanks to the AI-driven assistance, noting that no amount of manual review could match the depth and speed of the CodingGuide analysis. Moreover, the seamless integration and minimal disruption to workflows made it a clear choice for their organization.

"Many other tools out there claim to use AI or have some form of AI technology. However, I don't think they are as advanced as CodingGuide, which has been thoroughly tested and has specific targeting capabilities. Plus, it doesn’t add to user fatigue or require additional time investment; instead, it aims to give providers back valuable time in their day," said Kate Rothenberg, Director of Clinical Decision Support at CHN.

Kate Rothenberg, Director of Clinical Decision Support at Community Health Network

Final Thoughts

The successful integration of PINC AI™ Stanson’s CodingGuide not only transformed CHN's coding accuracy and provider efficiency but also exemplified the power of collaboration and innovation in modern healthcare. By harnessing cutting-edge AI technology and fostering a culture of continuous improvement, CHN has set a new standard for clinical documentation excellence.

Looking ahead, CHN remains committed to leveraging the capabilities of PINC AI™ Stanson’s CodingGuide to further optimize patient care, streamline workflows and drive meaningful outcomes across the healthcare landscape.

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