Cerebral is a virtual mental health care provider with a mission to provide access to quality care for all. Members can choose from several full-service monthly subscriptions and receive online access to therapists and prescribers.
Visits are conducted via video chat and members can message their care team directly. Members can have medications delivered directly to their door.
THE PROBLEM
Unfortunately, Cerebral’s chart review process was entirely manual and was time-consuming and costly.
The manual internal auditing and monitoring processes required hundreds of hours each month from a team of clinical auditors who were responsible for individually identifying notes to be audited, going through a process of creating a select sample of clinicians to audit, issues or topics to be audited for compliance or conformity, and ensuring that previous audit findings were not repeated in the environment.
“To obtain a relevant selected sample, the monthly manual build required a review of hundreds of physician calendars and appointments to identify and copy links to medical records into the electronic medical record so that the actual session notes could be found for review,” said Julia Dolan, deputy director of behavioral operations at Cerebral.
“Findings and observations were then recorded separately in another document, analyzed and summarized in a report for management and the individual clinician, and finally summarized separately for corporate leadership and management,” she continued.
The process was not only time-consuming but also prone to human error. The successful completion and evaluation of vendor audit results depended on the auditor’s meticulous attention to detail.
“They had to enter the physician’s name and medical record number into an evaluation template that was used to document the feedback,” Dolan explained. “Of course, this brought with it typical audit risks, such as name confusion, incorrect links, or failure to apply an audit component to a chart.”
“We have remained committed to continuous improvement and iteration to ensure high-quality audit feedback. We have identified gaps in the manual process and have remained diligent and proactive with the resources available to us – no small task for clinical management,” she added.
SUGGESTION
The provider Brellium offered an AI-based chart review technology that Managing unstructured clinical notes by leveraging artificial intelligence to perform comprehensive audits in real time. This technology aimed to address a major pain point in healthcare administration: the inefficiency and errors in clinical documentation due to manual processing.
“The core functionality of the system was to pre-screen all unstructured clinical notes for various types of errors and inconsistencies that could potentially impact the quality of patient care and/or insurance billing, such as patient sentiment, successes and follow-ups, evidence-based interventions, and determining whether treatment goals are measurable and time-bound,” Dolan explained.
“The AI has been specifically trained to detect clinical errors and identify trends that may require attention,” she continued. “This preventative analysis is also designed to ensure that billing and/or coding errors can be identified and corrected prior to insurance claims being submitted, significantly reducing the risk of claim denials and the need for costly rework.”
In addition, by automating the review process, the technology promises to reduce the amount of time healthcare providers spend on manual reviews by 98%, she added. While traditional methods typically only allow a small portion of patient visits to be thoroughly reviewed, with this AI-driven approach, Cerebral was able to increase the percentage of notes reviewed, thereby boosting review coverage. At the same time, the labor-intensive task of manual review was drastically reduced – with a time savings of 78%, she said.
“This significant improvement in efficiency freed up significant resources and enabled healthcare providers to focus more of their time and efforts on customer-facing activities and other administrative areas,” she noted.
MASTERING THE CHALLENGE
In December 2023, Cerebral began using the automated chart review process in its behavioral care department. Faced with the challenge of processing thousands of therapy session notes each month, Cerebral needed a scalable system to ensure compliance with its internal quality control and compliance requirements, as well as insurance mandates – without the prohibitive burden of manual reviews.
“Our clinical team worked directly with the provider to a customized AI system that integrates Cerebral’s unique meeting note formats, service schedules, and insurance partners’ specific audit requirements,” Dolan explained.
“After creating individual question sets and parameters for each note template type, Brellium’s system automatically reviews session notes from Cerebral’s electronic medical record and highlights necessary adjustments. This significantly reduces resources spent on administrative reviews and frees up more time for patient care, while reducing the risk of financial loss from insurance claims,” she said.
RESULTS
Within six months of implementing AI technology, Cerebral saw a dramatic 81% improvement in key underwriting criteria compliance and a 78% reduction in chart review time, indicating significant gains in operational efficiency.
In addition, Cerebral saw an 8% improvement in average physician audit scores from March to June 2024.
ADVICE FOR OTHERS
“AI-powered chart review has enabled us to expand our documentation review in an objective and operationally efficient manner,” explained Dolan. “Cerebral can more efficiently review trends and error patterns using accurate data feedback that may be missed during manual reviews.”
“In turn, we have been able to more easily identify areas for improvement and implement additional training across our clinical teams in a more meaningful and effective way to drive continuous improvement,” she continued.
The AI-supported diagram review has led to a significant increase in the efficiency of Cerebral’s workflows and improved the quality of note documentation, they concluded.
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