Combined approach to provide health plans with an end-to-end risk adjustment solution for superior performance
January 14, 2019
NASHVILLE, Tenn.—Change Healthcare today announced that it is collaborating with Health Fidelity, Inc. to offer a risk adjustment solution that embeds natural language processing (NLP) and machine learning technology into its risk adjustment coding offering to help Medicare Advantage, ACA commercial, and Medicaid payers increase claim accuracy and better address compliance obligations.
In today’s value-based environment, health plans are under mounting pressure to submit well-supported codes, and the cost of non-compliance can be substantial. However, risk adjustment remains a predominantly manual and tedious process in which coding specialists review records for unreported risk conditions. Now, leveraging Health Fidelity’s NLP technology, coders will be better able to prioritize and review charts with greater accuracy and compliance.
“Risk adjustment requires a high level of clinical data acquisition and careful analysis of millions of medical records to assign the proper diagnosis code to claims,” said Doug Duskin, senior vice president and general manager, Clinical Review, Change Healthcare. “Health Fidelity’s NLP engine has demonstrated very high sensitivity in identifying ICD and HCC codes, enabling their clients to realize a 20-30% increase in risk capture. This added capability is exciting as we expect it will lead to better gap closure and improved quality of care and outcomes for members.”
Change Healthcare offers Risk Adjustment Coding for payers that need accurate supporting data from member medical records to drive and help improve risk scores. Health Fidelity’s technology is a natural complement to these services and offers customers a highly flexible solution that can be tailored to their requirements, surround the problem, and deliver high-quality coding.
“With their scale, established payer relationships, and years of coding experience, Change Healthcare is the ideal partner to extend the reach of our natural language processing within risk-adjustment coding,” said Steve Whitehurst, Health Fidelity CEO. “The resulting combination of analytics, artificial intelligence, and services allows us to customize our solutions to meet customer goals and improve overall performance and outcomes.”
The combined Change Healthcare–Health Fidelity offering represents a single enterprise solution covering analytics (identifying which medical charts to examine for which patients), chart retrieval, coding, and submission. The application of NLP technology during the coding phase provides greater accuracy, which in turn translates to better compliance and more precise reimbursement.
About Health Fidelity
Health Fidelity delivers comprehensive, scalable risk adjustment solutions for risk-bearing entities that participate in Medicare Advantage, ACA, Medicaid, and Medicare ACO programs. With a combination of big data analytics and natural language processing (NLP) technology, Health Fidelity’s modern prospective and retrospective risk adjustment approaches extract valuable insights from medical records, changing the way risk is identified, quantified, and managed for enhanced operational, clinical, and financial outcomes. Learn more at www.healthfidelity.com.
About Change Healthcare
Change Healthcare is inspiring a better healthcare system. Working alongside our customers and partners, we leverage our software and analytics, network solutions, and technology-enabled services to enable better patient care, choice, and outcomes at scale. As a key catalyst of a value-based healthcare system, we are accelerating the journey toward improved lives and healthier communities. Learn more at changehealthcare.com.