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Use Cases

Importance of Provider Productivity In Value Based Care

Financial Risk

Implications: Financial risk transferred from payers to network provider entities

Critical Success Factors:

  • Carefully scrutinized group of providers within the ACO tier based on quality, cost, and efficiency of care
  • Proactive monitoring of provider productivity and strategies to drive accountability down to the provider level.
  • Coordinated and proactive disease management, case management and utilization management to improve clinical and financial outcomes
Financial Risk

The Big Challenge – Accelerating Shift to Value

Clear goals and timeline are set shifting reimbursements from volume to value

Payments through alternative models

Bundled Payments

BUNDLED PAYMENTS

ACCOUNTABLE CARE ORGANIZATIONS

Fee-for-service linked to quality and value

Value Based Purchasing

VALUE BASED PURCHASING

READMISSIONS REDUCTION HAC REDUCTION

Where can data science make a difference?

Insights to better manage population health

Insights to focus on measures that will drive maximum impact

Health Analytics

Every healthcare encounter contains valuable data points that can be harnessed to improve outcomes and reduce cost. What if all these data points could be harnessed to answer the following questions?

Our population health analytics solution helps healthcare systems gain insights into such questions and provides actionable recommendations to better manage population health.

Specific opportunities for smart analytics in population health

Who are the top out of network providers/facilities?
What members are driving up utilization at these providers/facilities?
For what medical conditions?

Identify network optimization opportunities by analyzing risk adjusted quality, cost, and efficiency drivers of top non-domestic providers

What is the cost and utilization of healthcare within my population?
How much do high cost encounters contribute to the cost of care and where?
What are my top cost and utilization drivers?

  • Describe the current patient population
  • Characterize the high cost members

What is the likely impact of steering my patient population to the best providers?

  • Assess cost and quality of domestic and non-domestic providers using visually intuitive dashboards
  • Interactively model the impact of cost shifting strategies using hard facts
  • Assess the benefit of shifting from non-domestic to domestic institutions.

Optimize Incentive Linked Payments

Where should my institution focus in order to generate the maximum impact on incentive linked payments?

How is my hospital performing in incentive programming?
What domains and measures have the greatest impact on return?

Analyze the incentive program in terms of how performance breaks down at the domain level…

How can I optimize HAC reduction?

Understand how each measure performed within a domain, and how much they would need to improve to see your estimated penalty drop to zero.

Productivity Metrics

WRVU

THROUGHPUT

SCHEDULE

CAPACITY

COMPENSATION

COST

Productivity Metrics

wRVUs – Comparing Providers

wRVUs–Comparing Providers
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