Risk Adjustment

athenahealth Population Health

This worklist shows which patients have potential diagnoses for specified Hierarchical Condition Categories (HCCs). You can view patients with potential diagnoses based on the Medicare Risk Adjustment Model, print a list of HCCs for a patient, and export the list of patients. Care coordinators can submit patient risk scores to the PCP for review.

 

On the Main Menu, click Reports. Under POPULATION MANAGEMENT, click Risk Adjustment

 

 

 

Your organization must use athenahealth Population Health, and you must have a role that includes these permissions to access the Risk Adjustment Worklist:

  • Population Management: Risk Adjustment Dashboard
  • Population Management: Person Center: Risk Score
  • Population Management: Patient Population

 

 

  1. Display the Risk Adjustment page: On the Main Menu, click Reports. Under POPULATION MANAGEMENT, click Risk Adjustment.
  2. Filter by PCP, Payer, At Risk, and Medicare Data Provider (optional):
    1. Click the plus icon next to FILTER at the top of the page.
    2. Select your criteria and click Apply.
  3. Filter by end date (optional):
    1. Click END DATE at the top of the page.
    2. Select a year and click Apply.
  4. Add or remove columns from your view:
    1. Click MANAGE COLUMNS.
    2. On the left, choose the type of column to add, such as Patient Information.

    3. Choose a column heading on the right, such as Product, and click Apply.
      Note: Selected columns are highlighted in blue.

  5. Click a column heading to sort data numerically or alphabetically by that column.
    To reverse the sort order, click the column heading again.
    Note: An arrow appears to the right of the column heading to indicate how data is sorted.

  6. You can select additional column filters using the menus under Product, Group, Practice, Is Deceased, and Gender.
  7. Select Page — Check the boxes for the patients you want to select, or check Select Page for all patients.

  8. Click EXPORT SELECTED(#) to export a detailed list.

 

  1. Display the Risk Adjustment page: On the Main Menu, click Reports. Under POPULATION MANAGEMENT, click Risk Adjustment.
  2. Use the filters to help you locate the patient's group.
  3. Click a patient's name in the Patient column to view the list of suggested diagnoses for that patient.
    Next to each suggested diagnosis is the Risk Adjustment Factor (RAF), as well as the status of that diagnosis.

    • Not Submitted — Indicates that the HCC was not printed and provided to the PCP. This is the default status for any HCC in the window.

    • Coded — Shows that you received feedback from the PCP indicating that they diagnosed the patient for one of the codes in the HCC you submitted.
    • Submitted — Indicates that the HCC was printed and provided to the PCP.
    • Hidden — Any suggested diagnoses that are not relevant to the patient are manually "hidden" in the Risk Adjustment tab of the Person Center. You can click SHOW HIDDEN to display the list of Hidden and Confirmed diagnoses.
    • Confirmed — When any of the potential diagnoses come back to Population Health on a claim, the diagnosis is listed in the Hidden list with the status of Confirmed.
  4. Click Print below the last diagnosis to print a list of the potential diagnoses for the patient.
  5. Click the patient's name again to display the patient's Person Center.

 

 

 

Use this page to filter the patient list by PCP, At Risk, Payer, and Medicare Data Provider. You can also sort and filter each column. When the patient list includes only the desired set of patients, click a patient's name once to expand the row.

 

On the Risk Adjustment tab, you can see the list of suggested diagnoses for that patient. This list matches the list in the Risk Adjustment window on the Problems tab of the Person Center for this patient. You can print a list of HCCs for this patient and then display the patient's Person Center. You can also export a list of patients.

 

 

For information about HCC/RAF and patient risk adjustment in athenaClinicals, see Patient Risk Adjustment and the Patient Risk Dashboard.

 

If your organization uses athenaClinicals and athenahealth Population Health, data from both products can be used in athenaClinicals to provide more accurate and timely information about a patient's potential diagnoses and risk adjustment factor (RAF).

  • athenaClinicals uses preadjudicated claims data from orders placed during encounters.
  • athenahealth Population Health uses three years of historical post-adjudicated claims data provided by payers, including claims from outside the network.

The additional information from athenahealth Population Health can improve the diagnosis and treatment of chronic conditions, reduce manual coordination between ACO administrators and providers, and increase revenue for payment models that are calibrated to the RAF score of the at-risk population.

 

Because the post-adjudicated claims data from athenahealth Population Health is included, the Patient Risk dashboard in athenaClinicals shows you a more complete accounting of the following:

  • Potential and suspected diagnoses
  • Risk adjustment factors
  • Risk scores
  • Gap scores

 

 

To benefit from this integration, your organization must use:

  • athenaClinicals
  • athenahealth Population Health
    Note: You can use this integration if your organization is part of an accountable care organization (ACO) that uses athenahealth Population Health.
  • Data warehouse feed v1.1

The data warehouse feed v1.1 allows athenaOne to match patients in athenaClinicals with patients in athenahealth Population Health and allows preadjudicated claims data from athenaClinicals to flow to athenahealth Population Health.

 

If you are interested in this integrated functionality, please contact your athenahealth Population Health team to ensure that the appropriate waivers are completed.

 

 

 

 

Related Topics Link IconRelated Topics