Enhancing revenue capture and outcomes with advanced patient targeting
Business challenge
A large not-for-profit healthcare system faced challenges in risk adjustment and quality improvement programs for its 180,000 Medicare Advantage (MA) and Medicare Shared Savings Program (MSSP) members.
The system recognized gaps in its care documentation that were limiting its ability to proactively identify and address patient conditions, as well as risking its financial performance.
Point-of-care suspecting for Prospective Risk with Clinical Intelligence
The healthcare system worked with Reveleer to implement a point-of-care suspecting solution that leveraged more than 1,500 clinical rules to identify potential diagnosis gaps and suspected conditions.
Using the insights generated with the Reveleer platform, the system implemented a pre-visit patient review using Reveleer’s provider-friendly interface to simplify care gap identification.
The platform integrated with the system’s existing Epic EHR workflow – enhancing provider engagement with one-click suspecting – and generated daily detailed reports to support provider quality incentives.
Transforming revenue capture and care outcomes
By implementing Reveleer’s point-of-care suspecting solution, the health system made huge strides in revenue capture and care improvement. Engaging providers with a user-friendly interface and highly accurate clinical insights improved its suspect HCC provider address rate by 34% within a year. Furthermore, improvements in HCC coding and risk adjustment led to $18.5 million in enhanced revenue capture – a 6X return on investment.
Next steps: Advancing value-based care with Reveleer
The health system has successfully improved revenue capture and care outcomes by implementing Reveleer’s point-of-care suspecting solution. It plans to continue driving quality improvement and revenue capture using the Reveleer platform, allowing it to target the most critical care gaps in its patient population. As the technology continues to train on the system’s data, the accuracy of its results will increase, uncovering further insights into care gaps and helping the system become a top leader in value-based care.
Related Resources
.avif)
Accelerating Retrieval to Meet Audit Deadlines
Learn how a large state Blues plan accelerated record retrieval with Reveleer's AI-powered solution, saving time and resources.
AI to Accelerate Clinical Coding
Learn how a large state Blue Cross Plan transformed risk adjustment coding and improved overall efficiency with Reveleer's AI-powered clinical coding platform.
AI for Clinical Intelligence
Discover how an ACO leveraged Reveleer's AI platform for Prospective Risk Adjustment to enhance value-based care, streamline workflows, and drive better patient outcomes.
