If healthcare is going to truly be reformed and improved, three areas must receive focus—improving the experience of care; improving the health of populations; and reducing per capita costs of healthcare. This “Triple Aim” can be achieved through data collection and analysis of services received by patients—work that is aided by the implementation of the more specific and versatile ICD-10-CM/PCS code set.

This was the message delivered Monday by Dr. Sam Ho, chief clinical officer at UnitedHealthcare, during his keynote address at the 2013 AHIMA ICD-10-CM/PCS and Computer-Assisted Coding Summit, taking place in Baltimore, MD this week.

The Triple Aim can be achieved by leveraging data—data that is improved by the ICD-10 code set. Better data allows providers to adhere to evidence-based medicine, analyze gaps in care, and discover disparities in appropriate use and cost, Ho said. Meeting quality measures leads to achieving part of the Triple Aim, and ICD-10 helps providers and healthcare stakeholders better measure the feasibility and accuracy of quality metrics, Ho said.

The new code set also provides greater physician performance transparency, which improves a patient’s experience of care. Ho said UnitedHealthcare has been actively developing integrated data analytics to help support the Triple Aim, including its myHealthcare Cost Estimator, which allows patients to select providers based on quality care metrics and out of pocket cost info.

Perform Detailed Risk Assessments

ICD-10 is a “significant” event that doesn’t just impact payers and providers’ technology, but also their processes throughout the organization, Ho said. Other areas impacted by the transition to ICD-10 include policies and procedures, reimbursement, clinical care, operations, documentation and coding performance, and contracting.

Organizations should use data analytics to determine just how their various areas will be impacted by analyzing clinical and claims data in order to assess risks and prioritize ICD-10 remediation efforts, Ho said.

If an organization is going to achieve the Triple Aim, they must have a successful ICD-10 transition. Therefore, organizations must understand the projected impact of ICD-10 and areas of risk in their clinical, financial, and operational performance. This is done with a risk assessment that uses data analytics to identify impact areas, and aids stakeholders to remediate issues before, during, and after ICD-10 implementation.

When assessing clinical operations’ ICD-10 risk, for example, the documentation/coding, reimbursement, contracting, financial operations, and policies and procedures should all be examined, Ho said.

Questions to ask include:

  • Which codes are of the greatest concern?
  • What is the impact on productivity?
  • What type of physician clinical documentation improvement is necessary?
  • Are changes needed in our contracts to maintain context given the change to ICD-10?
ICD-10 Has Great Potential

While risks do exist, ICD-10 has great “potential” to help providers achieve the Triple Aim and transform healthcare for the better, Ho said.

“Develop a sound assessment strategy that includes the applications of analytics—this can help identify most pressing areas of risk to ensure there is a plan for addressing the issues that matter most within your organization,” Ho wrote in his presentation.