在人口健康中优化层次状况类别风险调整因子管理,使用快速流程改进方法
Karri L Benjamin1, Brett C Meyer1, Jeff Pan1
1University of California San Diego, San Diego, California, USA.
Population health management
|November 6, 2024
概括
医疗保险和医疗补助服务中心 (CMS) 的报销依赖于层次状况类别 (HCC) 编码. 这项研究使用了精益学方法来开发工具,改进了HCC风险调整因子 (RAF) 管理,并实现了4.1%的得分增加.
科学领域:
- 医疗保健管理的管理
- 提高质量 提高质量
- 医疗信息学 医疗信息学
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 的报销与层次状况类别 (HCC) 编码有关.
- 医疗系统中的风险调整优化通常涉及昂贵的图表审查流程.
- 之前的HCC管理工作流程实现是复杂的和孤立的.
研究的目的:
- 实施HCC-风险调整因子 (RAF) 改进工具,以优化HCC-RAF在人口健康中的管理.
- 利用快速流程改进方法来简化HCC编码和文档.
- 为了降低与传统图表审查流程相关的成本.
主要方法:
- 采用精益方法和快速流程改进研讨会 (RPIW) 来开发和实施工具.
- 创建了一套工具,包括提供者教育,提示表,临床冠军,审计,实践警报和决策支持工具.
- 将新工具嵌入到供应商团队的标准工作中.
主要成果:
- 在第一年实现了企业HCC-RAF分数4.1%的改善.
- 为提供商和团队成员开发了优化的工作流程和工具.
- 证明提供者愿意采用新工具,表明成功的文化变化.
结论:
- 精益改进方法促进了HCC管理工具的集体设计和采用.
- 精简的流程和新开发的工具优化了运营,减少了浪费.
- 提供商接受了这些工具,使他们能够更高效,更有效地工作.
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