Prospective pre-visit risk adjustment is a win-win for both patients and healthcare providers. It promotes better patient care, prevention of health issues, cost savings, and less physician burnout. This approach contributes to a more efficient and effective healthcare system with the well-being of patients at its core. Though prospective risk adjustment has many benefits, it also presents several challenges related to data accuracy and privacy. Successfully navigating these challenges is essential for the effective implementation of this approach in healthcare. In this blog, we will first discuss how prospective pre-visit risk adjustment is beneficial for patients and healthcare providers. We will also talk about the associated challenges with it. In the end, we will discuss HCC SAGE, which is a comprehensive solution to streamline prospective risk management.
How Prospective Pre-Visit Risk Adjustment Is Beneficial for Patients and Healthcare Providers
Improved Patient Care
By assessing a patient’s risk factors and health conditions before their visit, healthcare providers can be better prepared to address their specific needs. This can lead to more personalized and effective care, potentially preventing health issues from worsening or becoming more costly to treat.
Enhanced Preventive Care
Early identification of a patient’s health risks allows healthcare providers to focus on preventive measures. This means they can offer guidance and interventions to help patients manage their conditions and reduce the likelihood of severe illness. For example, if a patient is at high risk for diabetes, the provider can recommend lifestyle changes or regular monitoring.
Reduced Healthcare Costs
Identifying and addressing risks in advance can lead to cost savings for both patients and providers. Preventive care and early intervention are often less expensive than treating advanced health conditions, hospitalizations, or emergency care. Patients may incur fewer out-of-pocket costs, and healthcare systems can allocate resources more efficiently.
Enhanced Data Sharing
Prospective risk adjustment relies on collecting and sharing patient health data. This encourages improved communication and data exchange between different healthcare providers involved in a patient’s care, leading to better coordination and a more comprehensive understanding of the patient’s health.
Accurate Reimbursement for Providers
For healthcare providers, prospective pre-visit risk adjustment is essential for accurate reimbursement. It ensures that providers are compensated fairly for the level of care they provide, particularly when dealing with patients who have more complex or high-risk health needs.
Challenges Associated With Prospective Pre-Visit Risk Adjustment
Data Accuracy: Prospective risk adjustment relies heavily on patient health data, and the accuracy and completeness of this data are crucial. Inaccurate or missing information can lead to incorrect risk assessments and subsequently affect patient care and reimbursement.
Privacy and Security Concerns: Gathering and sharing patient health data for risk adjustment must be done with strict adherence to privacy and security regulations, such as HIPAA in the United States. Ensuring data protection while making it available for risk assessment can be a complex and sensitive task.
Risk Prediction: While AI and machine learning are used to predict patient risk, these models are not perfect. There can be inaccuracies in risk assessments, which may lead to underestimating or overestimating a patient’s health risks, potentially affecting care decisions.
Workload Management: Collecting and analyzing pre-visit risk data can be time-consuming for healthcare providers and lead to physician burnout. This additional workload can strain resources and potentially affect the time available for direct patient care.
Regulatory Changes: Healthcare regulations and reimbursement models can change over time. Adapting to new regulations and ensuring compliance can be an ongoing challenge for healthcare providers using prospective pre-visit risk adjustment.
HCC SAGE: A Way to Streamline Prospective Pre-Visit Risk Adjustment
HCC SAGE facilitates healthcare providers with Prospective Previsit Solutions by incorporating new-age technology, such as NLP and AI. It collects the patient’s data from clinical charts, pharma records, etc., and analyzes & reviews them. This lets convert symptoms, treatments, medications of patients, and risk factors into a knowledge graph. In addition, side-by-side claim output is also generated. The knowledge graph allows healthcare providers to obtain chart output and compare this with claim output. In the end, healthcare providers obtained pre-visit reviews that consisted of risk, suspected conditions, recaptured conditions, etc.
HCC SAGE easily integrates with electronic health records (EHR), enabling better patient data review, which includes lab reports, charts, claims, etc. Since new-age technology allows the processing of vast amounts of data, bridging the gap between past and present data, ensures no misunderstanding. Moreover, this tool provides timely interventions, aiding in to detection of chronic conditions.
Prospective pre-visit risk adjustment is one of the best ways to reduce physician burnout and provide value-based care to patients. However, there are some associated challenges with this. HCC SAGE is the new-age solution to reap the benefits of prospective risk adjustment.