San Francisco-based Innovaccer has found a way to help Medicare Advantage plans close care gaps, while improving Star ratings, the company contends.
Innovaccer’s solution package for MA plans, launched a year ago, includes FHIR ready-APIs, point-of-care alerts, provider performance analytics and holistic patient-360 profiles, according to Kanav Hasija, co-founder and chief product officer at Innovaccer.
Innovaccer developed the product because it saw that one of MA plans’ biggest problems was that they didn’t interact in the most efficient way with their in-network providers, Hasija says. Yet, to improve Star ratings and to improve care, collaboration is key.
Most MA plans were meeting with physicians in the network every month, either by visiting in person, sending emails or by faxing—all in “a very cumbersome process,” Hasija says of Innovaccer’s industry assessment. This process did not help physicians remember the care goals for each patient. The reminders were too far apart and too hard to access.
In addition, chart retrieval to audit for care gaps was time-consuming and costly for payers, he says. Paper chart retrieval costs anywhere from $ 35 to $ 40 per chart, Hasija says.
Innovaccer’s solution, which overlays on top of an EMR, enables health plans to talk in real-time to providers, highlighting care gaps and Star rating issues, without interrupting workflow, he says. Innovaccer’s MA clients, who have asked not to share their names, include one of the largest regional players in the Midwest and one of the largest MA plans nationwide, according to Hasija.
The MA plans that have tested Innovaccer’s solution over the past year have closed care gaps two-to-three times faster than plans who didn’t use Innovaccer’s solution, Hasija says. Chart storage and retrieval on the system, now digital and not manual, has allowed for analytics and has lowered the cost of chart retrieval dramatically. Digital chart retrieval costs $ 1 to $ 2 per chart. “They are loving it so far,” he says of MA plans.
The product is also helping to improve Star ratings. Recently, Innovaccer assisted a leading Puerto Rico- based healthcare IT company to enhance the Star rating of its MA plans by integrating disparate data sources and streamlining efforts to close gaps in care. The company tracked gaps in the network involving 15,000 members, prioritizing those that lacked annual wellness visits. As a result, Star ratings improved from 3.5 to 4.5, Hasija says.
In the near future, Innovaccer plans to add prompts for patients into the system, to tell them what to discuss with their doctors. “We have told doctors what to look for, why not tell patients what to talk to their doctors about?” Hasija says. “We want to engage patients, as well. If the doctors forget something, then the patient knows what to bring up.”
“U.S. healthcare is progressing in its value-based initiatives, and the increased focus on delivering holistic patient-centered care is a clear sign of that transformation,” Hasija says. “Patients have become enlightened, and they are making choices that offer them more services. The organizations that are able to offer more services and satisfaction are likely to succeed in the long run.”
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Abhinav Shashank, CEO at Innovaccer, says value-based care is the way forward in healthcare. “Every little insight we have could prove extremely instrumental in improving overall outcomes,” he says. “We have to extract full value out of healthcare data for it to mean something.”
CMS recently released its Value-based Insurance Design (VBID) model for CY2020, which will focus on lowering costs, boosting the quality of care and enhancing the efficiency of care delivery, Shashank says. These new regulations and beneficiaries’ inclination to MA plans makes it inevitable for payers to adopt methods to drive smarter clinical interventions.