Maximizing the Value of ICD-10

Ken Edwards ZirMedBy Ken Edwards, VP of Operations at ZirMed
Twitter: @zirmed

This is a moment in healthcare when we are laying the foundation for new capabilities, new precision, and new operational enhancements for healthcare organizations. If you embrace it–and if you lead your team to focus on maximizing the benefits of it–you will also be keeping your organization on the crest of the key major changes taking place in healthcare today.

That is true of vendors, providers, large healthcare organizations, payers, and every one of us who can benefit from this change–every one of us who is responsible for making this transition not just seamless, but purposeful.

For context, let’s look ahead.

Value-based care

Under ICD-10, every claim filed with a payer will contain significant–and significantly more detailed–information about the true health of the patient. In aggregate, claims data will paint a richer, more complete picture of the patient’s story. ICD-10 will create an information-rich, nationally standardized system that will help us understand the full picture of the patient when they are receiving care.

Doctors are expert at understanding the patient’s health. The gap historically has been one created by data siloes and by individual large data-sets that do not contain–on their own–the right or sufficient contextual information.

That is changing–and the change is coming along with other major developments in healthcare. As reimbursement becomes more and more closely tied to outcomes, it is incumbent upon all of us to take a leading role in supporting the integrity of the additional wealth of healthcare data we are introducing into the system. Not simply because this is how we will ensure the continued financial stability of healthcare organizations–but because this data will play a crucial role in public- and population-health management efforts. It will be factored into decisions that affect all of us–not just those who work in healthcare.

ICD-10 will provide additional and more granular detail about chronic diseases, comorbid conditions, disease-management best practices, and mental health care–just to name a few top-of-mind examples. In aggregate this detail will become a rich source of insight for evidence-based medicine and also has the potential to accelerate the research process since historical data (both coding and clinical documentation) will become more comprehensive and specific. The data will underpin newfound abilities to manage population health, as it will enable informed, accurate segmentation of patients within existing disease registries or among previously indistinguishable subsets of patients.

Fee-for-service isn’t going away, but as fee-for-value rises, identifying and addressing gaps in care (along with other aspects of population health management) will have greater and greater ability to impact your overall clinical and financial performance.
Fee-for-value requires clinical integration and comprehensive longitudinal records of care. The quality of those records starts with the granularity and quality of your documentation–aka the same foundation for coding accurately in ICD-10. Whether you’re striving to meet specific quality measures for a state incentive program, or taking on new risk-bearing contracts with payers, documentation will play a significant role in how successful you are under fee-for-value models. Among other things, it will determine how wisely you expend case manager hours and other care intervention resources.

My advice to you is: embrace the change to ICD-10.

About the Author: Ken Edwards is vice president of operations at ZirMed, specializing in operations management and leadership.