Certified Risk Adjustment Coder (CRC)

Predictive models help identify individuals at high risk for chronic illnesses. What can providers do with this information to lower medical costs?

1. Develop disease management education programs

2. Involve clinical staff in care coordination

3. Refer patients with chronic illnesses to another provider

4. Determine the return on investment for referrals to specialists

The correct answer is: Develop disease management education programs

Developing disease management education programs is an effective strategy for providers to lower medical costs, as it helps patients better understand their chronic conditions and the importance of adhering to their treatment plans. By educating patients about their illnesses, providers can encourage proactive management of their health, leading to better health outcomes, reduced emergency room visits, and fewer hospitalizations. Education programs can also teach patients how to recognize warning signs, thereby enabling them to seek timely medical attention before conditions escalate. On the other hand, involving clinical staff in care coordination is important for ensuring seamless communication and support among healthcare teams, but it does not directly address patient education, which can significantly impact self-management and compliance. Referring patients with chronic illnesses to another provider might disrupt continuity of care and could lead to increased costs if the new provider does not have the same resources or knowledge about the patient's history. Determining the return on investment for referrals to specialists is relevant for assessing financial implications but does not directly contribute to managing chronic illnesses and improving patient outcomes in a cost-effective manner. Thus, focusing on education stands out as a more direct means to control and reduce overall medical expenses through prevention and better disease management.