make it clear what technology Cognizant already has (Trizetto's tech) which reduces cost and risk; we need to have TPs ready to explain why we are saying a specific # of months. Explain execution of the project as well.
Patient Level Data Captured in CodeVantage
The strategy of CodeVantage is to develop patient-centric Code Halos which will collect and track individualized patient data, including: historical health documents, doctors’ notes, claims data, and lab and pharmaceutical data on an annual basis.
Hospitals will use patient data to accurately predict patients’ current and future disease burden and translate them into the appropriate HCC codes.
Accurate patient level data captured in CodeVantage allow hospitals to improve patients’ care
Hospitals will utilize the CodeVantage system (comprised of their patients’ individual Code Halos) to predict ancillary diseases and connect patients to the appropriate caregiver.
When a care-gap is identified, hospitals will be alerted by the CodeVantage system to connect that patient with the appropriate doctor to have their disease diagnosed and cared for.
To ensure efficiency and patient retention, the CodeVantage system will also provide a tool to ensure effective care coordination. CodeVantage will schedule patient appointments with the necessary doctors on the same day as their annual check up or another scheduled appointment.
Hospitals using more accurate diagnostic reports will experience increased reimbursement rates from MA
By ensuring patients are getting comprehensive care by having their diseased diagnosed and treated efficiently, CodeVantage will provide hospitals with a critical tool to capture patients full disease burden resulting in higher of MA payouts by preventing undiagnosed/untreated diseases from being missed.
Understanding Hierarchical Condition Categories (HCC) Scores
The Center for Medicare and Medicaid Services (CMS) reimburses Medicare Advantage insurance providers a flat per-patient, per-month fee regardless of the amount of services the patient utilizes.
The flat rate, however, is adjusted based on the clinically documented disease burden of the patient based on the assumption that sicker patients will be more costly to treat and therefore require higher reimbursement.
The rate received per patient is based on his/her HCC score, a score calculated on (1) a patient’s demographics and (2) submitted claims outlining, with medical documentation, any medical conditions the patient may have (i.e.: a patient’s disease burden).
The higher the HCC score, the greater the revenue-per-patient for the hospital.
How HCC Scores Apply to Hospitals
Hospitals are now forming their own insurance plans and/or accepting capitated contracts (risk-based) from insurance firms. Medicare Advantage, a risk-based contract, has been in existence since 1997.
Hospitals that enter into these contracts negotiate the percentage they receive of the flat payment that CMS pays to the insurance company (typically 85%), therefore hospitals in these contracts have a direct incentive to maximize the revenue-per-patient, or the HCC score.
Medicare Shares Savings Program (MSSP) also adjusts payment rates on the HCC score, making the HCC risk-adjustment methodology critical to revenue generation for hospitals