Patients without a coded diagnosis, Humedica’s research has revealed, represent a significant opportunity to improve care and reduce costs.
Analyzing a large data set, Humedica found that patients with major chronic conditions who are uncoded use far less primary care but much more acute care than patients with a coded diagnosis. What’s more, once the chronic conditions of uncoded patients were coded, their use of outpatient services increased nearly threefold and their clinical outcomes improved.
The key to finding uncoded patients and better targeting care is a robust population analytics platform that weaves together clinical and claims data.
Humedica’s analysis revealed that 37 percent of patients with a major chronic condition were uncoded at baseline. Practices using population analytics, however, were able to improve coding across all of the major conditions. For diabetes alone, the rate of uncoded patients was nearly cut in half, from 17 percent to 9 percent over two years.
On average, practices were able to decrease their rate of uncoded patients by 14 percentage points over 24 months. The largest improvement seen was a 23-percentage point decrease, from 52 percent to 28 percent uncoded, while the lowest was 8-percentage points, for a group that started with an uncoded rate of 35 percent.
Population analytics make it easy for providers to find uncoded patients. By quickly displaying chronic condition populations, practices can see trends and find at-risk patients with minimal effort.
While better coding improves fee-for-service revenue in the short term, it also helps providers prepare for accountable care. Identifying high-risk patients ensures they receive the right kind of care, and the right amount. This means re-balancing the mix of ambulatory care and acute care patients receive, leading to better outcomes and reduced costs.
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