customer success

The South Bend Clinic Improves RAF score accuracy and HCC coder efficiency

South Bend Clinic, located in South Bend, Indiana, is a well-established healthcare provider that has been serving the community since 1916. With a patient-centered approach to care, the clinic is home to approximately 150 providers who represent nearly 30 different board certifications. This diverse team of professionals is dedicated to delivering comprehensive and compassionate medical services, continuing a legacy of over 100 years of excellence in healthcare.

RESULTS

Proof in practice.

34% increase in the average RAF score.
$504,220 additional captured in RAF value in less than two months.
100% automated review of The South Bend Clinic’s HCC encounters pre-claim to ensure the most accurate HCC data was captured and submitted.

the starting point

Striving for value-based care

The South Bend Clinic made a commitment to aggressively move into value-based care to improve patient care while reducing costs. However, in order to take on more risk-based contracts, a scalable and cost-effective approach to ensure profitability was a necessity. The South Bend Clinic knew the key to their financial success in value-based contracts was accurate RAF scores. They had already made major investments in a population health management solution and worked to build an analytics infrastructure for case managers, care coordinators, and providers with the goal to provide comprehensive preventative care, fill gaps in patient’s care, and manage chronic disease.

While The South Bend Clinic made great strides on clinical initiatives,
they realized there was a missing piece–their RAF scores did not
accurately match up to their patient population. Their patients were
sicker than their RAF scores indicated.

“The increase in revenue, required zero process changes to our clinical operations and optimized our coder’s productivity. Aptarro’s HCC Coding Engine pays for itself ten-fold. Within 30 days we were up and running. On day one we saw immediate value by capturing missed RAF revenue. The increase in revenue required zero process changes to our clinical operations and optimized our coder’s productivity. Any value-based care organization should use Aptarro, it pays for itself ten-fold.”

Shannon HublerCOO

“In a single week we saw an additional $100K+ in otherwise missing RAF value by using the Aptarro’s HCC Coding Engine. With Aptarro’s HCC Coding Engine, we were
easily able to scale up with value-based contracts. The value of the Aptarro software is unprecedented; in fact, it’s a necessity for any organization with risk based contracts.’’

Kelly Macken-MarbleCEO

implementation and support

Allowing the team to focus on high-value encounters only

The South Bend Clinic hired a single HCC coder to concurrently review value-based encounters. They leveraged their coder and the Aptarro software to improve RAF scores through increased HCC capture/re-capture rates. The Aptarro software automated the review of 100% of The South Bend Clinic’s HCC encounters pre-claim to ensure the most accurate HCC data was captured and submitted. By flagging HCC coding gaps, the coder focused solely on high-value encounters needing extra attention.

Aptarro’s HCC Coding Engine:

Automatically reviews every encounter that is finalized in the EMR
Identifies encounters with HCC coding gaps and tasks them to coders
Enables a concurrent/real-time review of encounters opposed to costly retrospective reviews
Provides reporting which shows provider recapture reports, as well as added/deleted HCCs and their effect on RAF value

Striving for value-based care

Allowing the team to focus on high-value encounters only

See Aptarro in action.