Accountable Care Organizations

As the transition to value continues to accelerate, it will be important for ACO’s to leverage the analytic insight necessary to capitalize upon early opportunities. These opportunities set the foundation for future success.


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Engagement

We empower Physician leadership and analytic staff by combining unparalleled subject matter expertise with advanced, fully dynamic, visualization technology. 

  • View ACO performance across payers, and provider groups, simply point and click
  • Focus upon actionable items with custom dashboard designs
  • Identify and prioritize initiatives with the greatest ROI
  • Establish internal and external performance benchmarks

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Coordination

Disparate data from multiple payers can be mapped to a single standard visual interface. Our proprietary data mapping software eliminates the confusion caused by inconsistent coding conventions. We create a “single source of the truth” so that everyone is looking at the same data at the same time. 

  • Track improvement across payers on an enterprise wide level
  • Risk stratify your entire ACO population across payers
  • Consolidate payer-specific gaps in care performance measures into a common list of measures

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Cost Management

Long-term ACO success will require effective management on both a unit cost and fixed price basis. The rapid adoption of risk based payer arrangements and consumer oriented bundled pricing options will accelerate this change.

Monitor relative cost performance at the group or practice level.

  • Track stop–loss claims against policy thresholds
  • Compare ACO unit threshold levels to market averages
  • Develop unit cost trends for internal reporting and monitoring

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Network Optimization

Maximizing the use of network providers represents an immediate opportunity to capture new health system revenue and provide early ROI directly linked to your ACO. By identifying the root causes of out-migration at a service level basis, we prepare the way for a thoughtful strategy that collaboratively engages PCP’s and referring physicians in utilizing your network.

  • Assess network utilization patterns on a disease specific basis.
  • Monitor out-migration by provider type and specialty.
  • Flag network weaknesses and target expansion opportunities.
  • Leverage health system employee benefit plan to drive changes in network utilization

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Population Health

The transition to population health will accelerate as CMS and large commercial payers seek to expand early ACO initiatives. Significant membership base will be transitioned to those ACO’s with demonstrated capabilities to manage risk, improve outcomes, and continuously enhance the customer experience.

  • Identify common clinical conditions driving program cost
  • Monitor Payer attribution methodologies and patient distribution
  • Create robust base lines to assess adequacy of global rates
  • Provide in-house actuarial support to measure trends and set budgets
  • Track changes in chronic care high cost cases
  • Provide a separate development area for modeling future quality measures

 


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Workflow

We support your internal workflow process through the development of practice level reporting modules that can be tailored to your existing web portal. In addition, we can support external workflow development efforts by the export of relevant data sets for inclusion in customized workflow applications.

  • Develop dynamic patient level gaps in care performance improvement tracking.
  • Provide supplemental patient demographic and benchmark data for inclusion in ACO web portal.
  • Create PCP level performance reports for inclusion into overall ACO “score card” type development process.

 


ACO Tour

Capitalize on immediate opportunities to reduce gaps in care in order to maximize payer financial incentives. Utilize advanced predictive models to target prospective risk and identify case management opportunities.