After coding, highest-risk patients improve the most

Humedica’s analysis of a data set representing more than 4 million patients revealed that patients without a coded diagnosis are relatively high risk—and use less ambulatory care than coded patients.

But what happens after they are coded?

Newly coded patients, Humedica’s research team discovered, showed significantly higher rates of clinical improvement. Forty seven percent of diabetes patients with a newly coded diagnosis, for instance, improved on at least one clinical measure versus only 24 percent of those who remained uncoded.

There was also a link between degree of improvement and how well patients were controlled to start. After coding, those who improved the most were the ones who had the most room for improvement. Better coding, it turns out, helps identify Jeremy Orr, MD, MPHhigh-risk patients and enable significant clinical impact quickly.

As we mentioned in our last blog, however, being sicker only accounts for part of the reason uncoded patients fair worse. The other part is their inappropriate utilization of care.

Humedica’s research showed that newly coded patients who improved on two or more relevant clinical measures increased their use of outpatient care by 0.9 visits per year, on average. In comparison, those who experienced clinical decline only increased their outpatient care by 0.2 visits a year.

For accountable care organizations, the implications of this research are significant: by identifying high-risk patients and engaging them in the right kind—and right amount—of care, they can provide higher-quality care at a lower cost.

For more on this topic, please download: “Uncover the link between coding and better patient care

–Jeremy Orr, MD, MPH, Chief Medical Officer, Optum Analytics

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