Tele-Medicine Risk Adjustment
description
Transcript of Tele-Medicine Risk Adjustment
Tele-Medicine Risk Adjustment
Agenda
What is Medicare Risk adjustment?
Conclusion
Summery of project specification
Why Tele-Medicine?
Team Workflow
Design
Web based application
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• Implemented in 2003 - (MMA)• Became fully in effect in 2007
• Medicare risk adjustment model • Method which collects data from a large pool of
beneficiaries to estimate predicted costs on average for each of the component factors: age, sex, county of enrollee, known as demographics
What is Medicare Risk Adjustment?
• In the MRA model, each member has been assigned a risk score
• Member Risk scores are based on diagnoses submitted by physicians, hospital inpatient and outpatient facilities
• Member Risk scores are calculated based on diagnoses from the prior year Dates of Service
• MRA model groups the ICD-9 codes (encounter data) into HCCs (Hierarchical Condition Categories) that contribute to the member risk score
What is Medicare Risk Adjustment?
Team Workflow
1Dr. Jean Coppola – Pace University
Client
Ray – Community Urgent Care Holdings
Client
3Dr. Amar Gupta – Pace University
Client
Our team consists of 4 people with different skills:• Research• Programming• Web design• Testing
• We have weekly meetings every Thursday at 9 pm to discuss our work and the next steps
• 6 meetings with our clients till now
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– Browser based questionnaire to capture some high level data that would be sued by the managed care plans to identify at risk patients that may not be managing underlying conditions
– This could be done off a tablet - and then buckets that the managed care plans would have access to as they relate to their members
What do our clients want?
• Use friendly web based application:– Create Browser Base Additional Intake
Information Form • patients name, date of birth, gender, age, weight, height,
contact information, insurance plan with member id, primary care physician, last visits, underlying conditions, medications, blood pressure, and glucose
– HIPAA Compliant Database– Collect Data to identify ‘at risk’ patients for
not managing underlying conditions– Data will be generated into downloadable
reports
Project Specifications
Design
Design
Log in First (as Member or Insurance Company)Start a New RecordReview Your RecordFind a Physician (Online Session)
Personal Info: Name, DoB, Weight, Height, Phone #, SSN, Last Visit, Insurance Company, Policy Number, Underlying Conditions, Family History, Current Medical Conditions, Medication
Design
Data Storage
Start New
Main Page
EncryptedSorted by SSNHIPPA Compliant
Why Tele-Medicine?
• The use of telemedicine reduces travel and many other stresses for the patient
• It has allowed health facilities to expand their reach beyond their offices
• It allows hospitals to create networks to provide each other with support – By easily sharing their expertise outside their own institutions,
doctors can offer incredible value to their medical colleagues and those colleagues’ patients
Users
The users of the program will be able to log into their own accounts and have the option to select a variety of different conditions that patients could have
Insurance Companies
Health Care Professionals
Doctors
Testing Strategy
Collect data
Process data Outcome
THANK YOU!