Epic@UNC tools support providers focusing on risk adjustment and value contracts

On March 2, all outpatient providers and clinical staff will see new fields and decision support in Epic@UNC related to risk adjustment and Hierarchical Condition Categories (HCCs). (Internal medicine and family practice clinics went live with the same changes on Feb. 17.)

To help prepare practices for these enhancements, the Practice Quality and Innovation team has created an HCC toolkit (Intranet link) for providers, clinical staff and practice managers that includes an overview of HCCs, how best to navigate the HCC functionality in Epic@UNC and best practice ideas to achieve success when using HCCs. The toolkit also includes clinical documentation guidelines, tip sheet links, and Epic@UNC HCC report information.

As care is shifting from a fee-for-service/transaction-based environment to one focused on value-based-care and management of populations, providers will need tools to support higher diagnosis specificity and yearly assessment and documentation of chronic problems in encounters. Interventions to improve diagnosis and coding specificity or Risk/HCC scoring can lead to better quality and cost-efficiency ratings and higher bonus/lower penalty. Additionally, improved Risk Adjustment Factor/HCC scoring leads to improved performance on inpatient measures such as 30 day readmissions, 30 day mortality, and Medicare Spending per Beneficiary.

While these initial HCC tools are a great start in supporting provider interventions in Risk and HCCs, other tools will need to be developed and additional training for providers will be required. Dr. Edward Hu, a UNC REX Healthcare hospitalist, physician advisor, and Carolina Value Clinical Documentation Integrity Solution Team Sponsor, will offer sessions on the “What, Why and How to identify missed opportunities” related to risk adjustment and HCCs. We will follow up with additional details as soon as this training schedule is confirmed.

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