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Working in risk adjustment really excites me
because it connects my passion for chronic condition management.
It takes it out of
the problem-focused nature of health care.
Why are you here today?
What are your symptoms?
And really allows that full condition assessment.
I'm Stephanie Gardner.
I work with Optum's Risk Adjustment Market Solutions.
With the introduction of V28,
the market need for innovation
is more critical than ever
but ensuring full and accurate diagnosis coding
is more complex.
And that's just because there's a tremendous amount of data
that's just overwhelming payers and providers.
AI is helpful in that
it really helps us go beyond
some of the traditional programs that focused on structured data
and allows us to dig into unstructured data
that might exist in things like chart notes
and to do the most comprehensive assessment possible
for that patient.
We couple the AI algorithm with certified coders,
with clinical expertise,
who review and validate the results of the AI.
And by bringing those two together,
we can see a 5 percent increase in net new suspects.
And that's 5 percent of conditions
that are existing that are impacting the treatment of these patients
but were previously going undetected.
It's really exciting to see innovative approaches
to risk adjustment programs
that can make a big difference in our healthcare payers
providers, and patients.
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