We are honored that KLAS K2 Payer/Provider Collaborative, a group focused on reducing friction and facilitating trust, collaboration, and alignment between payers, providers, and HIT vendors, selected Moxe for a Point of Light Recognition Award for the third year in a row. KLAS gives its Points of Light award to celebrate payer and provider partnerships that enhance healthcare outcomes.
Since working with payers and providers to enhance healthcare outcomes has been our objective from the get-go, receiving this KLAS award is a major encouragement to our team. Bringing payers and providers together to share important clinical data for the betterment of patient care is a goal that unites us all and pushes us forward despite the challenges we face. The award reminds us that when we continue to try to do what’s in the best interest of both payers, providers, and the broader healthcare ecosystem, everyone wins.
I congratulate our Moxe team and am immensely proud of all of the work that went on behind the scenes to make this award possible, and am equally as proud of the two health systems—who would like to remain anonymous—and the health plan, AmeriHealth Caritas, for their collaboration to achieve the outcomes referenced in the KLAS case study, namely improving care-gap closure rates.
I’ll briefly highlight the problem we set out to help our partners solve, how they tackled it, and what the outcomes have been.
AmeriHealth Caritas (AmeriHealth), a health plan that serves over 2 million members, struggled to access accurate, timely clinical data to support quality improvement initiatives. Historically, they manually retrieved clinical data, which often led to delayed or incomplete medical records.
On the health system side, HIM teams at both health systems, which collectively have over 1,000 locations and 4,800 physicians, faced mounting medical record requests from AmeriHealth, especially during the busy HEDIS season.
Both AmeriHealth and the health systems were overwhelmed by the volume of data they needed to obtain and share, respectively, and the various formats in which the data needed to be delivered to comply with different regulations.
It’s not a new story: Virtually every health system and plan have been feeling the strain of an increased demand for data, shifting requirements due to evolving regulations, and less staff to meet mounting demands.
Ultimately, AmeriHealth Caritas partnered with Moxe and the two health systems to automate the chart retrieval process.
What does that look like? Well, instead of AmeriHealth contacting the health systems for the charts they need, our chart retrieval solution allows data to be sent directly from the health systems’ EHRs via an API that adheres to strict data release restrictions. We extract discrete data and send it to a data repository, where AmeriHealth reviews and submits data. Non-discrete data like clinical notes goes through a natural language processing (NLP) engine that extracts additional information on whether care gaps were closed, critical to meeting HEDIS measures.
AmeriHealth and the participating health systems should be commended for their spirit of collaboration throughout the entire chart retrieval automation process. From their data exchange pilot to their go-live—the total process took only 9 weeks—they did a fantastic job of communicating and seeking to understand each others’ data needs, pain points, and where they could make adjustments to improve the data sharing process for all parties involved.
As the Points of Light award celebrates, both AmeriHealth and the participating health systems have achieved notable outcomes since they automated chart retrieval.
Most measurably, perhaps, was the up-to 7% improvement in care gap closure rates achieved over the course of nine months. Since the award was issued, AmeriHealth continues to monitor care gap closure rates and reports they are trending in the right direction.
In addition to closing more care gaps, all participants have benefited from an improved ability to track and trend data for HEDIS measures, better HEDIS measures with accompanying financial outcomes, more streamlined workflows, and increased timeliness and accuracy of patient/member documentation.
For the health systems, automating chart retrieval has meant the automatic processing of more than 300k charts; reduced workloads for HIM, help desk, IT, and tech support teams; money saved by eliminating the need for contracted staff during HEDIS season; and improved payer relations through a 50% increase in program reporting turnaround times.
As we celebrate the successes that AmeriHealth and their health system partners have achieved with automating chart retrieval, we also look forward to helping more health plans and health systems meaningfully collaborate. Whether we receive external recognition or not (thanks again, KLAS!), our team always feels rewarded when we can help facilitate more seamless, secure, privacy-centric data exchange that benefits both payers and providers.
Access the full case study featured in KLAS’s 2024 Points of Light report below: