Medical record retrieval is labor intensive, consumes time and resources, and requires great patience and persistence—but it’s a crucial component of any risk adjustment or HEDIS® project. Is there a way for health plans to increase their retrieval success rate without simply throwing more money at the problem? How can they ensure they’re getting the best return on investment (ROI) in their retrieval initiatives?
The key is to analyze provider behavior patterns and re-direct resources to where they can be the most productive. Certain metrics, when analyzed in combination, can reveal where your retrieval approach may need refinement.
Retrieval success rate by provider site is one of these metrics. Every health plan has a target retrieval rate to hit, generally somewhere in the area of 85 to 90 percent. As demonstrated in the chart below, when Verscend analyzes our database of information on 1.7 million providers, we can clearly see that a small percentage of providers will rarely submit the requested charts. In this case, rather than waste time making a second or third call to these providers, a retrieval agent’s time is better spent making a fourth or fifth phone call to a provider’s office with a high likelihood of chart delivery.
other key metrics
Other data points that health plans should examine closely during their retrieval projects include:
Retrieval rate by number of contacts
Retrieval rate by contact method
Fees charged by the provider site
By creating a model that leverages historical data to determine how each of these factors increases or decreases the likelihood of retrieving the chart, and how the factors interact with each other, we can create an overall score for a record request.
Download our new Perspective on this topic to learn about these key metrics and the ways in which retrieval analytics can help you prioritize your medical record retrieval projects.
Jake Wirth is a senior analytic scientist in Verscend’s Payment Accuracy and Risk Adjustment business areas. He works closely with data management and product management teams, providing analytic support to improve customer savings. Jake holds a BA in Political Science from Brigham Young University and an MS in Analytics from the Institute for Advanced Analytics at North Carolina State University.