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!