Improving accurate documentation of disease burden with Artificial Intelligence (AI) chart review
2,800+ additional conditions captured annually with EHR-integrated provider workflows
accuracy rate increase of persistent HCC codes at Marshfield Clinic
additional annual revenue, attributed to provider documentation
additional annual revenue for patient care
Introduction
Security Health Plan, a not-for-profit health maintenance organization within the Marshfield Clinic Health System, is committed to improving members' health, managing healthcare costs, and providing a high-quality healthcare experience. Since its inception, Security has been dedicated to ensuring accessible and affordable health benefits for its members.
The history of Security Health Plan dates back to 1971 when it was founded as the Greater Marshfield Community Health Plan, the first health maintenance organization (HMO) in Wisconsin and one of the first rural HMOs in the nation. Reorganized as Security Health Plan in 1986, the Health Plan has continued to grow and adapt, driven by a mission to provide comprehensive, cost-effective healthcare coverage.
As part of the Marshfield Clinic Health System, Security Health Plan benefits from a robust Health System provider network that includes over 50 locations and 1,500+ providers in more than 170 specialties. This affiliation empowers Security to integrate clinical excellence with personalized, compassionate service, all aimed at enhancing the well-being and quality of life for its members throughout Wisconsin.
Risk Adjustment and Documentation Accuracy
Improving Medicare Advantage (MA) documentation accuracy
Security Health Plan and Marshfield Clinic Health System were looking for opportunities to improve the quality of care and enhance patient outcomes for their growing base of MA members by adopting a systematic way to identify members’ disease acuity at scale. Security deployed Notable’s AI-powered Hierarchical Condition Category (HCC) Chart Review, first at a number of small clinics, collaborating closely with providers to gather feedback. From there, the team was able to iterate quickly and expand to an enterprise-wide deployment in just three weeks – achieving full deployment in under three months from kickoff.
Following the implementation of Notable's HCC Chart Review, Security's Health System provider network was able to fully and accurately document more than 2,800 additional conditions annually across more than 15,000 members reviewed within the Security Health Medicare Advantage population. This provider documentation of conditions addressed at the point of care translates to an additional $5.4M annually, reflects the disease acuity, and enables Security to provide additional benefits to take care of their members’ healthcare needs.
Notable's suspecting tool for new condition discovery also identified 440 conditions that were addressed and submitted by providers in the first eight months of 2024, translating to more than $1.7M in additional revenue for improved quality of care for members.
In total impact for Security Health Plan, these results drive a $467 per member per year (PMPY) improvement across its Medicare Advantage population with charts reviewed as patients of Marshfield Clinic Health System.
Across the entire Marshfield Clinic Health System population, they saw a 6.4% increase in complete and accurate documentation of persistent HCC codes. Notable’s HCC Chart Review helps the full Marshfield organization capture approximately 7,000 additional conditions annually – putting the combined organization on track toward their annual redocumentation targets.
Impacting care in the 2024 measurement year
With an enterprise-wide deployment completed in only three months, Security Health Plan has made a measurable impact. For the first time in several years, Security is on pace to meet their complete documentation and coding goals.
Building on the MA rollout success, Security expanded Notable’s HCC Chart Review to their Affordable Care Act (ACA) population. The team deployed the solution in one month.
Driving increased provider adoption in native EHR workflows
Through the deployment of AI-powered automation, Security Health Plan has significantly improved the provider experience. Notable's HCC Chart Review goes beyond merely presenting suspected diagnoses; it embeds concrete evidence directly from the patient's chart in the provider's Electronic Health Record (EHR) workflow. This unique feature allows care team members to bypass the time-consuming task of sifting through cluttered patient charts and problem lists to identify pertinent diseases.
Notable's integration into point-of-care workflows within the EHR has garnered praise from Marshfield Clinic Health System providers. One of the physician champions for this work, Tim Golemgeski, MD stated, “It’s just easy. All the information is in one place, and it’s concise and accurate. We have a few different tools for addressing HCCs, but Notable’s Chronic Condition review is a one-stop shop.”
A thoughtful change management process, supported by Security Health Plan and Notable’s partnership, enabled a successful enterprise-wide launch. Activating key stakeholders, including the CMIO, clinical leaders from both organizations, and coding leaders from the health plan, fostered enterprise-wide buy-in across both organizations.
During the deployment phase, Notable's team worked onsite at eight clinics, standing shoulder to shoulder with providers. This hands-on approach ensured alignment with provider workflows, the sharing of educational materials, and the successful drive towards increased provider adoption.
Leveraging AI to drive action
Security Health Plan leveraged Notable’s artificial intelligence platform to incorporate structured and unstructured data in risk adjustment opportunity identification.
Leveraging automation and AI to review patient charts avoided hours of manual chart review work from providers and staff that would have otherwise been required to drive additional condition capture. This automated work expanded the capacity of Marshfield’s existing staff, rather than requiring additional staff dedicated to chart review.
Going beyond data aggregation and workforce time savings, Security was able to drive action by presenting results to providers in an actionable format that improved accurate clinical redocumentation of persistent HCC codes by more than 6%.
Future expansion of impact
Moving forward, SHP and MCHS plan to continue their momentum in improving HCC recapture rates to exceed the 88% annual recapture rate goal. To drive further impact, they also plan to expand HCC Chart Review to cover specialty visits.
Expansion and additional flows
Engage and enroll new Medicare Advantage members
Marshfield Clinic Health System drives improved patient access with additional flows on the Notable platform. Building on the Marshfield integration, Security Health Plan has been able to engage prospective members when they receive care at Marshfield during pre-appointment check-in engagements. By reaching individuals in their trusted care delivery environment, Security unlocked a novel pathway for prospective members to learn about Security enrollment opportunities.
Within the first week, there was a 13.4% patient engagement rate, far exceeding typical industry benchmarks.
Care gap closure
Marshfield Clinic Health System is in the midst of deploying automated care gap closure flows to optimize quality metric performance. Check back soon for updates and results.
