Tele-Medicine Risk Adjustment

Agenda What is Medicare Risk adjustment? Conclusion Summery of project specification Why Tele-Medicine? Team Workflow Design Web based application ✓

Implemented in (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 1 1 Dr. Jean Coppola – Pace University Client Ray – Community Urgent Care Holdings Client 33 Dr. 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 2

–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

Log in First (as Member or Insurance Company) Start a New Record Review Your Record Find 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 Encrypted Sorted by SSN HIPPA 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

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