Innovating risk adjustment strategies

Renown kicked off the risk identification and capture program by implementing tailored training sessions. The trainings covered clinicians' expectations, detailed descriptions of Optum SmartForms that identify and document the hierarchical condition category (HCC) risk, and information on how providers could engage in Renown-sponsored incentive programs to encourage complete and accurate documentation.

Renown found that ongoing training was essential for continued success. Clinicians at Renown have access to an Optum multispecialty team of operational, clinical and technical experts to provide guidance on the risk identification and capture program. They also receive at-the-elbow training, live and recorded training webinars and reference materials, such as written and video-based aids and workflow documents.

In addition, Renown receives monthly reports that identify opportunities to enhance patient engagement and outreach, close clinical risk gaps and improve the provider experience through greater adoption and utilization of tools designed to simplify documentation during patient visits. Dr. McCormack also participates in quarterly benchmarking sessions with other providers nationwide to learn about and share performance metrics and best practices.

In just two years, Renown Medical Group advanced significantly from primarily paper-based, retrospective risk participation to incorporating tech-enabled risk adjustment into their EHR workflow. This integration has not only reduced administrative burden on providers, but also provides a more complete picture of patient diagnoses.

Renown developed a streamlined workflow for suspect identification. First, a team of abstractors at Renown reviews suspect documentation and determines whether the evidence points to a patient having a specific (yet undocumented) diagnosis. If yes, the system prompts the provider to confirm or clarify the diagnosis and provide documentation and an appropriate care plan at the point of care.

This method utilizes technology to ensure funding matches the care the patient requires. In value-based care, funding for providers is determined by the severity and complexity of the patient's condition. If a treated condition isn't documented during a patient visit, the care required for that condition will remain unfunded. Abstractors employ technology to identify any oversights, ensuring that the funding accurately corresponds to the patient’s actual acuity and complexity.

Renown has also excelled in gathering feedback from specialists to determine the relevant documentation codes for each specialty. This feedback is used to tailor the solution to meet the expectations of their specialty leaders. For instance, SmartForms, which allow providers to assess conditions in an easy-to-read format, display only the diagnoses relevant to a particular specialist. This approach minimizes unnecessary information and reduces documentation fatigue.

Since initiating the program, Renown has demonstrated sustained year-over-year improvement. For instance, their risk identification and capture rate stood at 79.9% in August 2022, rising to 89.0% by August 2024. This steady progress underscores Renown's advancing effectiveness and efficiency in moving towards value-based care.

Renown actively engages patients and empowers clinicians by ensuring precise documentation of chronic conditions throughout the consultation process. The success of the Renown Medical Group program can be attributed to several critical factors: dedicated clinical leadership and robust engagement, significant adoption by both primary and specialty care providers which helps alleviate some of the administrative burden that typically falls to PCPs, and strategic investment in refining abstraction and suspecting workflows. These elements are essential for driving continuous improvement and enhancing patient care at Renown.

Optum collaborates with organizations to develop a risk adjustment strategy using technology that accurately documents chronic conditions at the point of care. Our approach combines industry expertise and best practices to help healthcare providers demonstrate a comprehensive and clinically supported understanding of patient complexity and improve outcomes.