Based on Current Diagnostic Coding, Starling Patients are Healthier than Average
In 2016, most Starling contracts with Medicare Advantage plans provide an opportunity to share in savings if we provide care more cost effectively than the projected budget would predict. Budgets for Medicare Advantage (MA) are set by anticipating the services that a population with the health profile /disease burden of our patients is expected to need. The health profile is developed by the health plans based on the diagnostic coding submitted on claims for our patients.
In 2015, the diagnostic coding we provided positioned our patients as healthier than the average MA patient. Because many of our MA patients are seeing specialists who treat their chronic illnesses (in some cases receiving the majority of their care from specialists) is not likely that our patients are as healthy as they appear. As a result, it looks to the health plans as if we’re delivering services for a much sicker patient population than the one we have (based on our current coding).
One of Starling’s goals this year is to focus on capturing all appropriate diagnoses when patients present for care. Particular attention to HCC coding (described in greater detail in the attached presentation) will create a truer picture of our patients’ acuity and health risk, which will lead to a more accurate (higher) projection of the expected budget for their care. When our actual expenses are compared with a budget for a sicker-than-average population, our performance is likely to look much more favorable, and we are more likely to achieve shared savings.
The Allscripts EHR is designed to prompt providers to address HHC codes during a visit (see attached screen shot), making it easier to capture this coding in the months and years to come. Each step in capturing the full breadth of the work we do will enable us to tell our story more completely, be recognized and rewarded for our strengths and identify places where we can continue improving.