Since 2009, many healthcare organizations have worked diligently to plan and execute the revamping of systems and processes for a successful transition to ICD-10. But a successful transition by the healthcare industry at large is far more important than the success of any individual stakeholder or organization.
Through many previous healthcare mandates, most recently HIPAA 5010 implementation, we’ve seen that focusing outside the walls of your own organization can improve collective performance. As such, when WellPoint initiated its ICD-10 initiative, leaders challenged everyone to achieve a higher standard – and to support and drive readiness not just for our company, but also for the industry as a whole.
Many have bemoaned the key failure of HIPAA 5010 implementation: lack of cross-industry communication about readiness and testing done in silos. In order to make the most of the next 24 months, we must heed the lessons of 5010 and test, test, test, with a focus that’s simultaneously internal and external. From the outset of its ICD-10 efforts, WellPoint redefined its testing strategy and worked with an increasing number of our provider networks, data trading partners and vendor partners to examine impacts of the move from ICD-9 to ICD-10. Together with these partners, we have seen the critical importance not only of testing early, but also of analyzing the impacts on reimbursement and operations.
Real Data Makes a Difference
We modeled expected shifts in reimbursement (i.e. DRG variance) using internally generated data and engaged our provider partners to produce natively coded ICD-10 claims to run comparisons – and the contrasts between manufactured and real data have been telling.
Together we validated significant differences between our modeled data and the real data in areas such as cardiac services. Additionally, we identified data quality issues and changes in coding patterns that influence claim adjudication. Those influences impact both health plans and providers.
This early work will help us improve how we process claims and utilize ICD-10 in analytics, and will lead to a smoother transition for us and our partners.
The insights that came from working with real ICD-10 data, produced directly from our providers, validated a hypothesis: that real data provides better insight than manufactured data. We all should be testing with real data, and we need to consider new scenarios to leverage it effectively. We need to use that data to gauge targeted and expected outcomes if our testing is going to be valuable for us and our stakeholders.
We ultimately coined a new term, “continuity testing,” which involves taking the mystery and fear out of ICD-10 adoption. The new approaches to testing (which are not as complicated as building an aircraft carrier or putting a rover on Mars) are laser-focused on a couple of processes.
First, ensure stability in operational costs by testing system configuration that could result in negative outcomes if the configuration inaccurately or inappropriately applies ICD-10 codes. These negative outcomes could include scenarios like increased claim issues, representing a situation we and our stakeholders both want to avoid (remember, collaboration benefits everyone).
Second, create predictability of legitimate shifts in institutional reimbursement or shifts in professional analytics that influence quality and performance programs. These shifts can be legitimate, a hypothesis already proven with our provider partners. Creating a sense of certainty and security through collaboration, again, benefits everyone.
With the publication of the final rule and the ICD-10 compliance date set officially as Oct. 1, 2014, it is time for the industry to maintain the momentum and innovation necessary to plan, to collaborate, to test and to succeed.
Now is the time for engagement between providers, payers, practice management and clinical information systems vendors in order to identify ICD-10 impacts. Break down barriers and build collaborations that will yield insights to ensure continuity and drive value out of ICD-10. Plan to participate in end-to-end testing with your partners.
And most of all, be ready for Oct. 1, 2014.
About the Author
Ian Bonnet is a vice president of enterprise ICD-10 adoption and insurance exchange implementation for WellPoint where he leads the enterprise wide adoption of ICD-10 across all business and technology areas. Ian is actively engaged in facilitating collaboration between industry stakeholders on the most challenging aspects of ICD-10 adoption. He received a BA in Biology from the College of Charleston and an MHSA from Arizona State University.
Contact the Author
To comment on this article please go to email@example.com