Among this big data, it’s important to capture and analyze both structured and unstructured information. As much as 80 to 90 percent of today’s health data is in unstructured formats like patient histories and physician notes. It’s unfortunate because there is so much valuable information that lies in all this untouched data. Tools that help clinicians extract this critical information, especially for risk adjustment, can have a significant impact on practice efficiency, cost savings and patient outcomes.

HCB News: Can you explain why risk adjustment is increasingly critical for healthcare organizations?

DS: Risk adjustment is critical, particularly now as we’re moving to value-based care, because it’s used by the Centers for Medicare and Medicaid Services (CMS) and many commercial payer organizations to more accurately predict the health costs of each patient and adjust reimbursement rates accordingly.



For instance, CMS uses a Hierarchical Condition Category (HCC) risk adjustment model to calculate reimbursement rates for organizations participating in the Medicare Advantage program. However, many diagnoses today are often coded inaccurately or not coded at all in the patient record. This can negatively impact risk scoring by clinicians, resulting in inaccurate or unrealized reimbursements.

HCB News: At HIMSS15, Healthline announced Coding InSight, a new coding optimization application built on the company’s HealthData Engine. How does this new application address risk adjustment?

DS: Coding InSight helps providers, payers and accountable care organizations better manage patient population risk and improve health outcomes by effectively closing risk adjustment gaps. It does this by leveraging Healthline’s proprietary health taxonomy (a health graph of the millions of medical concepts and semantic relationships in healthcare today), natural language processing technologies and advanced data analytics to uncover missed or inaccurate codes from unstructured patient data and close those gaps prospectively and retrospectively in near-real time. As a result, clinicians are able to improve efficiency, reduce costs and accurately realize reimbursements, while also optimizing risk scoring of patients and facilitating timely interventions for improved outcomes.

HCB News: What makes Coding InSight different from other risk adjustment products on the market?

DS: Unlike other risk adjustment solutions, Coding InSight features prospective coding optimization, enabling providers to capture coding opportunities right at the point of care before actually submitting the encounter to payers. Coding InSight also uniquely leverages Healthline’s proprietary HealthTaxonomy, the world’s largest and most comprehensive medical taxonomy. This allows Coding InSight to intelligently make coding recommendations simply based on the existence of certain medications, procedures, labs, etc. in the patient’s record. This is something that many solutions on the market today struggle to do.

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