HiLabs

MCheck™ Clinical – Driving Value Through Interoperability Across the Data Chain

Overview

MCheck™ Clinical is a cutting-edge product that helps health plans leverage clinical data to drive value throughout their data pipeline by transforming their operations from being reactive to proactive. The MCheck platform is built with integrated medical ontologies developed through years of training on healthcare data by experts. The platform empowers public and private sector health plans to make use of their clinical data to improve their data quality, operational efficiency, and overall member experience.

Key Use Cases/Solutions

Clinical Data Interoperability

MCheck™ Clinical automatically ingests and quality checks billions of clinical records automatically, ensuring providers are submitting complete data and accurately discovering where there are clinical data gaps.

HEDIS

HiLabs’ products can identify gaps in HEDIS data and care by analyzing a member's structured and unstructured data holistically. It assists health plans in meeting NCQA timelines by performing near-real time HEDIS gap identification to ensure early detection and intervention to close the gaps. Reducing the number of charts to be chased by 1/10th, the platform has a fully automated report generated with only minimal manual analyses required.

Health Effectiveness Data Information Set (HEDIS®) by the National Committee on Quality Assurance (NCQA) is an important quality metric for health plans. A same set of clinical encounters is used to get both risk adjustment and quality datasets. There is missing data and duplication of records and efforts if the risk adjustment and quality departments are not in sync. Data and care gaps are almost impossible to find by employing traditional rules-based approaches. The accuracy of risk profiles is crucial for effective risk adjustment allowing health plans to be appropriately compensated for the risk of their enrollees. At HiLabs, we have experts who perform reviews of both HEDIS and risk adjustment.

Risk Adjustment

HiLabs’ platform is adept in identifying the suspect upcoding/down-coding and data gaps and errors, helped by MCheck’s out-of-the-box proprietary algorithm that comes with an expertise of 2.5 billion HCC coding patterns. It achieves documentation mining from structured as well as unstructured data. It is capable of suspect analytics and identification of undocumented conditions is possible without the need of medical charts. It allows auto-identification of members’ charts with potential missing code(s). The solution prescribes specific diagnosis code(s) to search for while reviewing those charts using NLP and Medical Ontology-based expertise. The health plans receive the benefit of having their risks evaluated and costs saved.

Approach

MCheck™ Clinical is a comprehensive AI/ML and NLP-based data monitoring solution. The platform can be leveraged to either replace or complement existing clinical operability solutions and process, helping the organization scale, automate, and improvise with its clinical data.

Value for Customers

Operational cost savings

Our platform provides automated provider onboarding and data interoperability with reduced turn-around time for data validations.

Increased STAR/HEDIS ratings

Proactive and early identifications of data/care gaps help drive HEDIS/STAR ratings.

Increased Revenue

MCheck™ Clinical derives AI/ML based insights from data to improve patient outcomes, value-based care, and other revenue drivers of any health plan.

Reduced penalties

It helps plans predict data issues upfront and avoid the hassles related to penalties.

Features

Advanced NLP

MCheck™ Clinical was developed with embedded medical ontologies and is instrumental in extracting meaningful insights from otherwise incomprehensible, unstructured data such as physician notes and medical charts.

Multi-Faceted AI/ML

MCheck™ Clinical provides a comprehensive data error detection solution using AI/ML patterns which provides actionable insights and root-cause analyses that can result in cost savings for public and private sector health plans.

Pre-built suite of industry standard checks

MCheck™ Clinical comes pre-packaged with industry standard data quality checks that can be used as is or configured in modules to suit the needs of our customers.

Why MCheck™ Clinical

MCheck™ Clinical is infinitely scalable and capable of processing and analyzing billions of records with >95 percent error detection accuracy. It can perform instant root cause analyses and data forensics to continuously provide actionable insights to our customers.

Mcheck™ Clinical