Physician Care Centers, a fast-growing value-based primary care group, is deploying a solution from Colorado-based startup Credo to quickly gather and synthesize patient documentation.
Physician Care Centers has offices in Georgia, Florida, Texas and South Carolina, and will soon expand into Arizona and Virginia. It serves approximately 50,000 patients in some variation of global or partially capitated risk in Medicare Advantage.
Logan Steele, vice president of operations, said all the new-patient acquisition requires a lot of document chasing. “In some of our high-growth markets, we typically see anywhere from 10 percent to 20 percent new membership growth, just net new to the practice,” he said. “Getting records on the members can sometimes be extremely difficult. With this PreDx solution, instead of a process that would take months to gather a comprehensive medical record on a member, we're able to get it in a matter of days.”
Denver-based Credo says PreDx offers digital access to 85,000 health systems and clinics combined with manual curation to fill any gaps. Once Credo obtains a patient's medical records, it uses in-house clinicians, along with machine learning algorithms developed through its own custom training data, to analyze and deliver a comprehensive medical history report that consolidates all documented conditions of the patient with references and dates of service.
“What we've done at Credo is built an engine that goes out and gets all the clinical data on a patient before a patient encounter,” said Carm Huntress, CEO of Credo. “Beyond using health information networks, we have our own team that will phone and fax for records on behalf of the provider and the patient to get the records.”
He said they get about 40 to 50 clinical documents per patient. “We have a tool that goes through and synthesizes that data, using AI and machine learning and we label the patient's conditions and the current status of those conditions and what's going on and the severity,” Huntress added. “That produces a summarized report and we push that back inside the EHR for the provider to review as part of that encounter. That greatly improves the quality of the treatment, and the cost of the treatment because they're not doing as many tests. Ultimately, we tend to find two to three conditions that the provider was unaware of, and that's incredibly important not only to treat the patient, but from a risk adjustment standpoint — finding new codes and improving the quality of the reimbursement they get from CMS. We ultimately play into compliance and auditability because we're not just relying on some claim, we actually have the clinical documentation proving that these patients do have these active conditions and the provider needs to treat them.”
In a March 2022 interview, Huntress told Healthcare Innovation that he isn’t looking for Credo to become a big data aggregator. The company’s goal, he said, is to use various “digital on-ramps” and be more efficient than hospital and physician group staffers or traditional vendors in “chart chasing” and filling out providers’ pictures of their patients. Credo is focusing on Medicare Advantage and other value-based care providers, charging a flat fee for successful placements of data and then a subscription fee for keeping current those records.
Steele said Physician Care Centers started a pilot about a year ago and scaled it up six months ago. “I think we started with about one-tenth of our patient population and then slowly grew that up,” he said. “But recently, we've begun to go to an enterprise-wide onboarding because Credo does more than just retrieval now. It's a much more comprehensive approach to document retrieval and synthesis. There are a lot of HEDIS requirements both on the MA business but also in ACA and Medicaid around retrieving documents, whether it's a colonoscopy or a transition of care document. Typically this requires, asking the specialists at the health system to provide that documentation. Now Credo handles all those requests for us. So we've seen a very large increase in our quality numbers. In addition, the auditability of this platform is a plus because there is much emphasis now on accurate and precision documentation. This allows my organization to have a full timeline of document retrieval, from identification to diagnosis and then as it navigates through the revenue cycle management process.”
Huntress said there are a lot of providers starting to take on delegated risk and they do not have significant technology capabilities. “They're relying on their EHR and that's about it in terms of technology infrastructure,” he said. “We bring in an entire team, a platform and all the integration pieces to make this work for them.”