Innovations and Efficiencies in Home-Based Care: HCCI Solutions Suite for NPHI Members-Day 2 Recording

Video Transcription

Video Summary

The first video summarizes Dr. Aaron Yau's discussion on HCC coding and risk adjustment. He explains that risk adjustment is used by CMS to predict healthcare costs based on chronic diseases. Risk adjustment is important for Medicare Advantage plans and value-based care models. Dr. Yau discusses risk adjustment factors (RAF) that consider demographic information and diagnosis codes. Accurate coding for chronic conditions can increase practice payments. He emphasizes the importance of capturing all chronic conditions and coding specifically. The video concludes by highlighting the need for a mindset change in accurately coding chronic conditions.<br /><br />The second set of summaries provides recommendations for managing heart failure, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). These include optimizing medication therapy, monitoring parameters, educating patients on symptom recognition, lifestyle modifications, coordinating care with specialists, and regular follow-up visits.<br /><br />The third summary discusses the development and implementation of triage protocols in a home-based care practice. Triage protocols address common patient concerns and guide the urgency of needs, allowing providers to focus on complex patients. It emphasizes the importance of aligning protocols with evidence-based guidelines, clear communication channels, and the role of triage as initial guidance, not a replacement for healthcare provider evaluation.<br /><br />The fourth summary covers two case studies, Ralph and Betty, who have complex health needs. It emphasizes involving a multidisciplinary team, medication reviews, addressing social determinants of health, safety in home visits, and coding opportunities for accurate billing practices.<br /><br />The fifth and final summary concludes the HCCI Putting It All Together workshop by thanking participants and highlighting the value of home-based medical care. The video encourages reaching out to the HCCI team for further questions or resources.

Keywords

HCC coding

risk adjustment

CMS

chronic diseases

Medicare Advantage plans

value-based care models

RAF

diagnosis codes

practice payments

capturing chronic conditions

heart failure

CKD

COPD

medication therapy

follow-up visits