Facing Increasing Requests From Payers, Atrium Health HIM Automates Response

Oct. 13, 2022
Atrium implemented Moxe Health’s Digital ROI solution to automate HEDIS and Medicare risk adjustment requests from two of its largest payers

Like most health information management (HIM) offices, the one at Atrium Health was facing an ever-increasing volume of chart requests during HEDIS  and Medicare risk adjustment (MRA) seasons. To manage the increase in requests, the North Carolina health system chose to automate the release-of- information process, which allowed the HIM team to get back to focusing on patient requests.

Atrium Health is an integrated, nonprofit health system serving patients at 40 hospitals and more than 1,400 care locations. Hannah Sorgius, HIM director at Atrium, said an increasing number of requests were coming from payers. On average, the call center was fielding 5,000 calls a week, with about 500 related to HEDIS and MRA requests.

They come in seasonally, so roughly two to four times a year we were receiving large influxes of requests that we weren't necessarily staffed for,” she said. All of the retrieval work was manual. Along with the requests, she added, “come all the phone follow-ups, all the erroneous faxes, the third-party companies hired to go out and retrieve this data showing up at our clinical care sites and interrupting patient care.” Atrium did not want to pull in teams from other tasks or hire temporary staff to address spikes in volume, but they wanted to address the burnout employees were feeling from the additional requests.

A few years ago, Atrium decided to adopt an automated digital solution from a Madison, Wisconsin-based company called Moxe Health. The company says it improves collaboration by digitizing medical charts and enabling bidirectional data exchange between providers, payers, and third-party requesters.

Moxe worked with Atrium to design and test their instance of Moxe’s Digital ROI solution to ensure it fully incorporated Atrium’s specific release restrictions. By building the restrictions into Digital ROI, which sits within the Epic EHR, Atrium can retain control of patient data. 

“The tool that we have in place with Atrium really does automate the whole process. The payers deliver the requests to Moxe electronically,” said Beth Zuehlke, Moxe's chief customer officer. “Our system picks those up and goes about the process of matching and making sure that we're respecting all of Atrium’s policies and procedures of how they release information. We then package it up and electronically deliver it to the payer. All of that actually happens behind the scenes without a human intervening. One of the fun things about Atrium is we've actually been able to support them across two EMRs. When we originally implemented with Atrium, they were using Cerner as their clinical EMR and now I think their whole organization is up on Epic, and we've been able to transition pretty seamlessly over and are continuing to support them.”

As Sorgius and Zuehlke explained, they had to work through specific Atrium policies and procedures about release across all of their departments, with a sensitivity around behavioral health units. Depending on the state that the health system is operating in, there are regulations around how different lab results can be shared. The length of implementation depends a little bit on the EMR. “But for Epic sites, we can take somebody lives in a six- to 12-week timeline pretty seamlessly,” said Zuehlke. “There are only a few things we need from the health system’s technical team. We handle the testing and once we've got that connection live, we can use that connection between Moxe and the health system to be able to facilitate multiple payer requests. If we are on-boarding new payer, the Atrium team doesn't need to do anything. We ask Hannah if this is a payer that they are interested in connecting to. Hannah and her team are the ones that make the decisions about who they're going to connect to and what they will release. We just facilitate their decisions, but there isn't an additional technical lift on their side.”

With the new “information blocking” rules going into effect this month, it becomes even more important for HIM departments to be ready to respond to patient requests for their records, and in digital format if they request them that way. The automated solution “has really allowed us to just regain focus on the why we're here, which is for our patients, and being able to fulfill their request in whatever format files they would like,” Sorgius said.

In one year, Atrium automated retrieval of 70,000 charts and estimated that it saved 3,500 hours in manual chart retrieval, and that 26,000 phone calls were eliminated.

“We've saved year to date now about 3.7 FTE since implementing Moxe,” she said. That includes the actual manual processing of the charts that the team did and also the amount of phone calls that came in that the team was fielding to talk about chart retrieval. “It has really lightened the burden on our call center, allowing them to refocus on our patients. Our patients have less wait time. They can get to a live answer a lot quicker and then we've been able to redeploy teammates to reduce our turnaround time for our patients and patient care.”

Zuehlke also spoke about the benefits of this type of automation on the payer side. If they're not getting electronic data, they're deploying people to make those phone calls or even sending people out to health systems to go on site and, and collect them. A lot of that administrative burden decreases, she stressed. “Also, when they send us requests, we give them daily updates of the status of their requests. Approximately 80 percent of the time, they are completed and returned to them within 24 hours. We're giving daily updates on the status of each request, so they no longer have to wonder what's happening if there is a long turnaround time for delivery,” she said. “We can deliver the data in machine-readable format, so the payer can consume that information in a standard mechanism. They don't have to care which health system it's coming from, which EMR it's coming from. They're getting it in a standard process, which is important. Even from one Epic site to another, the way that they produce a chart can be done very differently even though the base EMR is the same.”

I asked both Zuehlke and Sorgius how common this type of automation is now across the industry and how many health system HIM departments are still pulling these charts manually.

“We definitely are seeing faster reception to this overall. I think, actually, the pandemic was a little bit of an eye-opener for some HIM departments who had to go virtual. If they were heavily reliant on people in person to respond to these requests, they all of a sudden had to figure out how to automate more,” said Zuehlke. “The fact that the requests from the payers have continued to go up is putting even more pressure on the health systems. One of the big reasons why payers need the volumes of data as they look at things like Medicare risk adjustment and HEDIS is that they're really looking for how to measure care across a population of people The more important those programs become to the healthcare ecosystem, the more important it is to have interoperability to facilitate large amounts of clinical data change.”

“I think in HIM, we're not necessarily known as early adopters,” Sorgius added with a laugh. “But in the last two to three years, I have found a lot more HIM directors across the nation are looking for more ways to automate than previously. The thought process had been that a human has got to lay eyes on this, but as we get more into interoperability and data sharing at many different levels in an organization, HIM is now starting to come to the table and realize we can have a part in this, too. It does not have to be so manual.”

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