Health Fidelity, UPMC collaborate on provider point of care risk-capture tool using NLP

UPMC has started using Health Fidelity’s latest product to help the health system’s providers better understand the health of their patient populations – a key metric in the move to value-based care.

UPMC also helped develop the product, HF360 Provider, which automates and streamlines the risk adjustment process for physicians and other members of the care team using Health Fidelity’s natural language processing (NLP) engine, REVEAL.

Rather than utilizing manual reviews by medical coders to capture risk by assigning patients the appropriate Hierarchical Condition Category (HCC) – which requires substantial time, resources, and budget for an entire population – HF360 Provider scans all relevant records, suggests appropriate HCC codes in real time, and integrates directly with the electronic health record (EHR).

“Risk adjustment is very complex and physicians often focus on providing patient care rather than ensuring all medical details are properly coded in the EHR. Physicians want to identify patient risk and address it at the point of care,” said Adele Towers, MD, Senior Clinical Advisor, UPMC Enterprises.

“Prior to the HF360 Provider, that wasn’t possible. This revolutionary technology provides the information physicians need before, during, and after a patient visit to help create a more complete and compliant reimbursement picture.”

HF360 Provider allows health care providers to better identify, capture, and document risk across Medicare Advantage, ACA, ACO, and Medicaid populations without disrupting existing clinical workflows. The result is twofold, better patient care and more complete documentation for reimbursements.

To develop the solution, Health Fidelity tapped into its partner, UPMC and its vast knowledge as a large integrated health system. This proved to be valuable as UPMC and UPMC Enterprises could share clinical insights and technical details. The team began by consulting with physicians to better understand their existing process and identify key pain points.

Major findings provided further evidence that physicians and clinical staff required a tool to help streamline the documentation process by helping to identify specific conditions. With a clear direction set, the final step was working directly with the UPMC Information Services Division to discuss the implementation process and integration with Epic EHR to help ensure the final product accurately addressed these points.

Health Fidelity’s solution standardizes the process behind the scenes by organizing activities into three specific workflows: pre-encounter, point-of-care, and post-encounter. Each step engages the physician and the care team by providing them with a patient-centered workflow and actionable data consistent with their typical process.

In the pre-encounter workflow, HF360 Provider highlights existing or suggested HCCs, which the physician can confirm or deny to update a patient’s diagnosis list during the visit. After the visit, the post-encounter workflow scans all EHR information to suggest any additional HCCs that may have been noted, but not fully captured during the visit.

This holistic approach, all centered around the patient encounter, allows providers to identify, target, document, and code for all risk adjustment gaps. This also helps ensure optimal accuracy and provide a more complete picture of patient and population risk.

“UPMC has been a visionary development partner for Health Fidelity’s solutions,” said Anand Shroff, Founder and Chief Development Officer, Health Fidelity.

“With support from UPMC Enterprises, we’ve been able to engage directly with the health system to move risk adjustment closer to the physician workflow, making it more efficient in the process. In turn, patients can receive better, more complete care for all conditions, and physicians can be properly reimbursed for the risk they take on,” Shroff said. “We are confident that HF360 Provider will be a driver of Health Fidelity’s continued growth, particularly with UPMC’s development insights and validation as an early adopter of the solution.”

UPMC has already begun using the HF360 Provider tool, launching a post-encounter pilot in several practices and plans to expand use to several more facilities across the health system.

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