Annual Wellness Visits & Provider Portal

Effective HCC recapture is a reconfirmation process, somewhere between a census and an audit. It establishes that patients are still covered, and their conditions are still managed year over year. HCC recapture is also subject to constant attrition even when performed perfectly; patients move to other areas, obtain other methods of covering the costs of their care, or they pass away.

 

It is imperative for the managed care and risk-bearing organizations’ leadership to understand the status of their HCC recapture rate and AWV rate of completion monthly. Well-managed data reconciliation workflow and HCC recapture tracking system will help:

  • Conduct a comprehensive health assessment for each member.
  • Determine each member’s health risk status and appropriate care plan.
  • Promote members’ involvement in their own care.
  • Assist in proper documentation for healthcare effectiveness data information set (HEDIS), star ratings, and hierarchical condition categories (HCC).
  • Maintain compliance with value-based care programs

Providers and provider groups play a critical role in ensuring the integrity of the data used in calculating the overall health risk of members. As healthcare moves from volume- to value-based delivery models, the AWV addresses gaps in care and improves patient outcomes.

Key Features of AWV Module

Invent Health’s MAP platform supports a workflow-enabled AWE module that helps health plans and providers work collaboratively to manage annual wellness visit programs. The AWE module supports the review and captures accurate documentation from practitioners, primary care providers, and provider groups—in turn, it helps patients stay healthier.

  • Track the annual health condition status for each member using the pre-built AWE FORM templates
  • Reconcile HCC conditions and medical record documentation sufficient to support HCC conditions for every member  
  • Track and review documentation, and request/upload additional clinical documents to the highest level of specificity
  • Track member-level AWE status through the customizable workflow and implement a collaborative workflow process to approve, review, and hold completed AWE forms
  • Enable incentive programs and payment reporting at the member and provider level for completing annual wellness Visits
  • Automate checklists for provider outreach,allowing coding teams to review the submitted and incomplete AWE forms.
  • Risk adjustment departments can ensure encounter data submissions are timely, accurate, and robust (i.e. reflecting the level of diagnostic specificity found in the medical chart) 
  • Automated OCR processes to extract data from AWE forms and perform analytics and recommendations for provider outreach and HCC coding review teams. 
  • Integrate HEDIS and star rating quality data collection utilizing the AWE workflow process.
  • Risk analytics and reporting capabilities enable key performance metrics, monthly performance report cards, and actionable stratified data for providers to close gaps.
Benefits of AWV

Benefits of AWV Module

  • Simple tracking of patients due for AWV and recommend actions
  • Increase annual HCC capture rates by 10%.
  • Increased provider engagement and compliance through incentive payment programs
  • Customizable AWE forms and workflows for Medicare, medicaid and commercial lines of business.
  • Maximize health risk assessments to identify care interventions and goals.
  • Increase compliance across HCC capture rates, HEDIS and STAR quality metrics.
  • Easy accessibility for all clinical documentation for audit purposes.

Provider and Provider Groups

Provider Portal Module

Health plans are increasingly focused on avoiding administrative waste and promoting quality patient health outcomes. Health plans and providers needed real-time visibility to monitor and manage risk adjustment revenue against budgeted gap closures and key performance indicators (KPIs)

 

The Invent Health provider portal enables health plans and provider groups to work collaboratively, achieving precise risk adjustment analytics to manage Medicaid, the Affordable Care Act (ACA), and commercial and Medicare Advantage markets.

 

The MAP leverages aggregated data from various sources (claims, AWE, quality measures, clinical data)  in a sophisticated manner in order to gain a more complete understanding of members’ health, increase the ability to carry out targeted interventions and obtain a greater ROI. Provider 360 effectively enables providers to prioritize patients and identify open care gaps for proactive closure at the point of care support visibility to manage current, projected and suspected conditions.

Quality Reporting

Risk Adjustment

Financial Reconciliation

Provider Management

Care Coordination

Provider Portal Features

Invent Health Provider 360° approach considers risk adjustment optimization, including how to stratify membership for gap closures, enhance provider collaboration, integrate with multiple departments (risk and quality), and obtain performance control and transparency.

Near real-time visibility to key performance indicators (KPIs) like HCC capture rates and potential revenue opportunities

Displays a population-level view of gap closure opportunities, detailing which gaps have been confirmed and which gaps remain open.

Prioritizes all possible gap closure opportunities, recommends optimal intervention strategies to close the care gaps in an optimal manner through concurrent.

Provides detailed data analytics empowering healthcare providers to monitor HCC risk scores, track quality metrics, and care gaps that require intervention in optimized manner.

Provider Portal Benefits

With the executive and Provider 360 views, MAP prioritizes actionable data for leadership and breaking down departmental silos to set up a foundation for performance improvement.

For incentives, education, and tools to increase providers’ engagement with payer-led initiatives.

In provider engagement, member outreach, and data-driven prioritization for risk score gaps and quality score improvements.

Ensure maximum adherence to regulations and protect against possible audits and penalties.

Compared to their peers by taking a comprehensive approach to risk adjustment and risk-based programs.

Provider partners are equipped to deliver the right care to the right patients at the right time.

Create role-based workflows and custom KPI templates per line of business across risk, utilization and quality

Provider Portal (PPGs / IPAs)

Web-based provider portal exclusively for provider practice groups (PPGs) / IPAs

Provider Opportunity Report

Web-based provider opportunity report for provider and provider groups

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