Big Data Equals Big Success for Risk Assessment

An Innovative Apixio Solution Enables a San Francisco-based Medicare Advantage Plan to Improve Its HCC Coding Accuracy

SAN MATEO, Calif.--(BUSINESS WIRE)--Apixio, Inc., the leading provider of big data analytic and clinical data integration solutions for healthcare, partnered with Chinese Community Health Plan (CCHP) to improve its Medicare Advantage (MA) plan member risk assessment for the 2012 payment year. Using the Apixio HCC Optimizer solution, generally available last fall, coders contracted by CCHP reviewed and coded conditions identified by Apixio’s automated audit algorithms. The process was over twenty times faster than manual chart audit alone.

“Many Medicare Advantage organizations are struggling to accurately compute risk for their member populations. Manual review of charts is very labor intensive and it is challenging to review its results for accuracy. Physician coding is notoriously inefficient”

“The Apixio HCC solution is the only solution in the market that I have seen to replace or complement human retrospective chart audits. The manual chart audit process is not only costly, but extremely limited in its scope and capacities, and is unable to properly capture true risk. This translates into lost plan revenue,” said Craig Reich, MD, Medical Director for CCHP. “With Apixio, we have a platform to efficiently review and legitimately code for properly documented diagnoses that have been ‘hidden in plain sight.’ The efficiency, degree of success and ROI delivered using this tool is nothing short of incredible!”

The HCC Optimizer is one of many applications powered by Apixio’s Big Data Platform, which analyzes data from multiple sources of various types, including coded, textual and scanned documents. The HCC Optimizer uses sophisticated machine-learning algorithms trained to identify properly documented diseases relevant for MA risk scoring that have not been coded that year. The application then presents the encounter note with the well documented condition for the coder to review and code if Medicare requirements are considered to be satisfied. As well, the HCC Optimizer provides a reporting suite designed to generate insights into coder efficiency and quality, and member risk.

“Many Medicare Advantage organizations are struggling to accurately compute risk for their member populations. Manual review of charts is very labor intensive and it is challenging to review its results for accuracy. Physician coding is notoriously inefficient,” said Darren Schulte, MD, MPP, president of Apixio. “Improper capture and coding of conditions negatively impacts patient care management, revenue, and audit risk. Computer-assisted HCC coding allows organizations to reduce errors, improve care, and use administrative personnel more wisely.”

About Apixio Inc.

Privately held and based in San Mateo, California, Apixio Inc. is the leading provider of big data analytics and clinical data integration in healthcare. Apixio’s cloud-based solutions help at-risk healthcare organizations achieve optimal quality, cost and revenue objectives.

About Chinese Community Health Plan

Chinese Community Health Plan (CCHP) is a health care plan delivering culturally sensitive, bilingual managed care to the San Francisco community since 1986.