The article discusses the crucial role of natural language processing (NLP) in value-based care, particularly for payers and risk-bearing organizations. NLP aids in accurately capturing patient disease risks by extracting important information from unstructured medical data, which comprises about 80% of health records. This capability is vital for effective risk adjustment and ensuring precise reimbursement in value-based agreements, such as Medicare Advantage plans.
NLP helps modernize the outdated chart review processes, foster interoperability in health systems, and enhance risk adjustment accuracy. It also enables the development of comprehensive patient health views by integrating data from varied healthcare providers. By doing so, NLP supports cost control, identifies patients at risk of disease progression, and pinpoints instances of overtreatment. Furthermore, it facilitates sharing insights with providers, strengthening collaborations to improve patient outcomes. With the increasing market focus on value-based care, NLP is becoming an indispensable tool for managing healthcare costs and delivering holistic patient care.