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CloudMedx Releases New Risk Adjustment Module For Large Healthcare Providers And Physician Groups

by Kerry Metzdorf
February 14, 2017

PALO ALTO, CA–(Marketwired – Feb 14, 2017) – CloudMedx, a Health AI analytics company, today announced its release of risk adjustment module as part of its Clinical AI Platform. For larger healthcare providers, physician practices, and systems they will now be able to leverage their unstructured data to automate their risk adjustments for high risk patients. For payers, they can now get highly accurate risk scores to assess the overall health of their risk pool, ensure that they are reimbursed appropriately by the Centers for Medicare & Medicaid Services (CMS) based on how sick their members actually are, and know whether they will receive transfer payments or pay them out.

Risk adjustment is a tool that allows payers to be reimbursed based on health status or “actuarial risk” of a patient population. It is designed to pay health plans more precisely for the anticipated health costs of a patient population by adjusting payments based on demographics and health status.1 These attributes are used to generate a risk score — a measure of a patient’s cost to a plan. As approximately 80% of the Medicare population has at least one chronic condition2, the clinical and financial impact of missing data is high, given the risk associated with an elderly population. Therefore, CloudMedx risk adjustment provides a quick snapshot of patients’ risks to payers and providers that are regularly affected by overlooked data.

How it is currently doneCurrently, health plans and providers continually conduct manual medical record reviews to identify additional conditions not captured through claims or encounter data and to verify the accuracy of coding. This is always done well after the patient has already been seen, diagnosed and treated by the provider, with little emphasis on longitudinal health care. This process is labor intensive, expensive and time consuming and can have serious repercussions on patient health.

“Physician data is critical for accurate risk adjustment as physicians are the largest source of healthcare data,” said Tashfeen Suleman, CEO of CloudMedx. “With CloudMedx’s risk adjustment module, we are automatically pulling charts out of EMRs, and using natural language processing to identify the correct codes, diagnoses and automatically risk adjusting patients based on CMS guidelines. This information can be provided within 24 hours so care providers can more properly assess patient risk, improving the course of treatment. Payers can use this information to more accurately reflect their patient risk pool, potentially leading to accurate reimbursement.”

How CloudMedx does it

CloudMedx combines a curated clinical ontology — a dynamic network of interrelated symptoms, diagnoses, medications, lab tests and procedures — with natural language processing so large volumes of unanalyzed free text (otherwise known as unstructured data such as clinical notes, discharge summaries, etc.) inform the patient risk profiles. This reduces the burden of the current risk adjustment pipeline that exists in many healthcare systems and leverages key data that hasn’t been used in the past. The logic is that if a clinician is armed with an extensive knowledge base combined with their informed observations, a holistic diagnosis can be made when the patient is being seen by providers. Further, if a patient’s risk score is correctly represented, the patient can benefit from appropriate interventions that can benefit their long term health.

Dr. Imran Hameed, CEO of All Medical Care IPA, stated that, “As an IPA, we believe that CloudMedx’s new module is the answer to many issues surrounding patient’s data collection and its proper and efficient use. The system is the much needed tool to collect the right clinical and financial data from doctors’ EMRs to identify sicker patients, missing quality metrics data and improve care quality and efficiency. What makes this module unique and effective is that it does this electronically and efficiently instead of current labor intensive mechanisms like chart review.”

CloudMedx can integrate directly with a provider’s electronic health record and workflow while providing insights that assist the physician at the point of care as well as coders that are assessing the clinical documentation. As more providers become integrated payer/provider organizations and as the healthcare industry is regularly improving risk adjustment methodology, CloudMedx technology can catalyze effective use of this vital tool. The potent combination of the CloudMedx Clinical AI platform and a clinician’s experience will have a very significant impact on how care is delivered.

About All Medical Care IPA

All Medical Care IPA (individual practitioner association) was established in the spring of 2012 by a group of 10 high caliber doctors and healthcare providers with impeccable reputations with a combined New York City practice experiences of more than 100 years. The goal of the IPA is to strengthen the delivery of healthcare by connecting physicians to meet the challenges of today’s complex healthcare system and bring about positive changes in it. Mr Joel Greenberg, Esq and Ms Claudia Hinrichsen, Esq, with extensive healthcare legal background helped establish the IPA. Imran Hameed, MPH, PhD, is the CEO of the group and has extensive healthcare management experiences which includes board and operations steering committee membership at Healthfirst HMO, director of managed care at Kingsbrook Jewish Medical Center, Brooklyn, NY, physician practice management, medical billing, outcomes manager at Schering Plough pharmaceutical company and related fields. Beverly Slater, RN, has an extensive clinical and management experiences, and is the network manager of the IPA.

About CloudMedx

CloudMedx is a “Clinical AI Platform” that provides precision encounters by offering real time and retrospective clinical insights at all points of care. The company utilizes evidence based algorithms, machine learning and natural language processing to read through structured and unstructured data sources and provides predictive analytics to support health systems and payers better manage their patients. Trusted by some of the best performing healthcare organizations in the country, CloudMedx is headquartered in downtown Palo Alto. More information is available at 2