Tackling interoperability and the growing demand for clinical data

In today’s healthcare marketplace, payers increasingly need accurate and comprehensive data about their members to inform their business decisions. And they need it now.

While payers have claims data across their membership, claims do not provide the whole story. In contrast, clinical data is contextual and comprehensive, painting a more holistic picture of a person’s health status. However, this data sits with providers in disparate systems and in a variety of formats.

Challenge = solution

With the growing demand for accurate clinical data driven by imperatives such as Medicare and commercial risk adjustment, quality improvement (HEDIS/Stars), and payment integrity, payers are overwhelming provider Health Information Management (HIM) teams with increasing requests for release of information (i.e., medical records). Fulfilling these requests has historically been a manual and cumbersome process, involving pulling, copying, and faxing paper medical records.

The good news is there is hope. One HIM team figured out how to simplify the release of information (ROI) process, which proved to be a game changer.

Last year, Novant Health, a North Carolina-based health system worked with Moxe Health (Moxe), a leader in clinical data exchange, to address one of the interoperability challenges many providers are facing head on. The goal was to automate the release of information process and alleviate the burden on Novant Health’s HIM team as they tried to manage an unsustainable workload marked by heavy spikes during risk adjustment and HEDIS seasons.

“We knew that there was a better way to respond and take charge of the heavy volumes of medical record requests we were receiving from all the payers we work with; just one payer was requesting about 20,000 charts from us annually to support their risk adjustment efforts,” said Joe Naretto, Senior Director, Health Information Management at Novant Health.

The large payer sending Novant 20,000 requests was also working with Moxe and introduced Novant Health to the data exchange company to help streamline the ROI process. Soon thereafter Moxe helped Novant establish an electronic connection that seamlessly plugged into Moxe’s network and quickly increased efficiency.

Beth Zuehlke, Senior Vice President of Customer Success at Moxe, said the magnitude of medical record requests is overwhelming for providers. “It’s very hard for providers to manage large volumes of requests. It can take 10 to 12 minutes to manually fulfill a chart request. When automated, we can process about 1,000 charts in an hour. That means providers are freed up to focus on what really matters: patients.”

Novant Health’s leadership knew they had to find a solution to address ROI accurately and effectively. “It just made sense for us to augment the way we work, to enhance our processes, and to leverage technology to manage the volume. It also benefits the payer as it is much faster,” explains Naretto.

“Based on the volume of requests that have been piped through Moxe since 2020, we’ve been able to reallocate up to approximately 20,000 labor hours within our HIM department. Shifting those hours from manually processing risk adjustment and HEDIS audits toward other request workflows and strategic initiatives allowed us to the flexibility and resources to drive improvement more broadly across our business,” Naretto said.

Novant started with one large payer and then expanded to connect with the other requestors in Moxe’s network. Zuehlke said, “Between February 2020 and September 2021, Moxe connected Novant to 10 additional payer requestors, fulfilling more than 260,000 requests. “

Naretto said supplementing Novant’s ROI operation with technology provides a significant “release valve” in dealing with cyclical pressures. “Risk Adjustment and HEDIS audits are seasonal and involve a very high volume of medical record requests. Automating most of those requests through Moxe allowed our team to shift focus to more patient-centric requests for information. It also gave us a more stable volume trajectory throughout the year; we didn’t have to keep reacting to large spikes of payer related audits,” he said. “This translated to a more balanced workload for our staff; they could take time off, attend trainings, or simply anticipate more predictable work assignments.”

Naretto said the key solution had to add efficiency while maintaining secure data exchange. “This was immensely important as we were forced to pivot ― almost overnight ― to a predominantly remote workforce in response to the Covid-19 pandemic. In absence of augmenting our operation with Moxe’s automation for these ROI requests, the remote pivot would have undoubtedly been more difficult.”

An equally if not more appealing aspect was the value-added benefit of having employees focus on areas that truly needed the human touch. “Working with Moxe, and the support that they’ve provided with payer demands, really allowed us to focus our efforts elsewhere. We can now spend the time on the areas that need a higher, human touch ― Moxe allows us to focus on areas where we can add the most value, the human factor,” Naretto said.

Naturally, employees were concerned that technology would replace them. But that wasn’t the case. “When you start talking about automating things, you often get the question. ‘Does that mean I don’t have a job?’ But people very quickly understood that once we were able to use this and really streamline thousands of requests coming in, we were able to shift our focus on more patient-centric work,” Naretto explained.

“At Novant, we set high expectations for ourselves, and our customers demand this same quality. By working with Moxe to digitize ROI, we’ve added another tool in our toolbox that helps augment our operations to drive efficiencies.”

Most health systems in the US are just like Novant Health, overburdened and in need of solutions that provide relief. “We feel for the providers and believe that healthcare operations should be simpler,” says Zuehlke, “our focus is on eliminating friction between providers and payers and making it easy to securely exchange clinical data.”

According to Naretto, the results turned out just as they suspected. “It was a really positive success story,” said Naretto. “Digitizing ROI was a win-win. We gained control of our workload, released timely and accurate information to our payers, refocused our efforts to better serve our patients, and improved our processes.”

With the goal of better healthcare for all of us, Moxe continues to expand its network of providers and payers to unlock the potential of clinical data. All the while, the number of use cases that lean on clinical data to drive healthcare outcomes grows, paving the way for interoperability.