Results
- eClinicalWorks® HCC module evaluates structured and unstructured data to highlight actionable HCC gaps based on historical coding.
- Empowers a network of over 160 providers with mid-year and full-year HCC recapture opportunities while calculating real-time, patient-level RAF scores.
- Delivers evidence-backed clinical support directly at the point of care, saving time and ensuring accurate risk adjustment without adding administrative burden.
“It provides very accurate coding opportunities to providers without wasting their time to look at some of the opportunities that are not relevant.”
– Mice Chen, Chief Information Officer, Prima CARE PC
Problem
Prima CARE PC, a large multi-specialty ACO with a significant Medicare Advantage population, needed a reliable way to document chronic conditions and manage risk adjustment. They required a comprehensive system to help their expansive network of providers accurately calculate risk scores, predict costs, and code Hierarchical Condition Categories (HCCs) without adding administrative hurdles or wasting valuable time reviewing irrelevant alerts.
Solution
By implementing the eClinicalWorks embedded HCC module, Prima CARE PC integrated a powerful tool that scans both structured and unstructured data, including claims and interoperability networks, to identify missed codes based on historical data. The backend dashboard allows their coding team to analyze Risk Adjustment Factor (RAF) score trends and filter opportunities, ensuring providers only see accurate, evidence-supported recommendations directly in the clinical panel.
About Practice:
Prima CARE PC is a comprehensive, multi-specialty healthcare organization that has been delivering evidence-based medical care since 1991. With a network of over 160 providers in Fall River, Somerset, and Westport, Massachusetts, and Tiverton, Rhode Island, they offer a wide range of services, including primary and specialty care, diagnostic testing, and walk-in clinics. Dedicated to the doctor/patient relationship, Prima CARE provides support across various settings, from offices and hospitals to nursing homes, ensuring patients receive compassionate, high-quality attention wherever they are.
