- Is your organization prepared to take on risk?
- Do you have the tools to manage At-Risk patients across all the dimensions of the continuum of care to maximize the revenues?
- Do you know who your highest risk patients are?
- Are you concerned about the Medical-Loss ratios?
We help health care providers and payers maximize service line margins. We accomplish this by identifying high risk patient populations along with the risk factors by using proprietary predictive analytics, then optimizing on interdependent and conflicting triple-aim objectives (reduce cost, improve outcomes and patient experience) across the continuum-of-care (acute and ambulatory).
Population Predictive Analytics for ACOs’
Stratify your population into risk pools based on real time clinical data from EMRs (and not retrospective claims data). Identify high risk patients and design individualized care programs to prevent hospitalizations. Design an optimal ACO network with the right mix of PCPs and specialists.
Pay-for-Performance for PCMOs
Track the population State-of-Health (SOH) scores by chronic condition to determine the effectiveness of a care management intervention. Ability to understand the impact of primary care on the per-member-per-month (PMPM) patient costs across the continuum of care. Develop strategic plans to forecast demand for procedures and specialist resources. Optimize provider network to lower costs and improve quality to maximize pay-for-performance incentives.
Clinical Integration for Hospital Systems
Minimize cost-quality-risk variances along multiple dimensions across the continuum of care. Estimate the impact of standardizing on best practices with real time “what-if” scenario planning. Understand the link between quality, cost and outcome (Triple Aim) across each dimension in order to align clinical teams, and meet performance goals for the new bundled payment models.
Lowering Medical Loss Ratios for Payers
Powerful interactive multi-dimensional claims analysis with “what-if” modeling capabilities to identify cost and quality improvement opportunities. Lower your business analyst staff with “out-of-box” analytics to maintain margins under the new medical-loss requirements. Identify provider network opportunities to lower costs and improve quality to design optimal pay-for-performance incentives.
- “The significant difference between early models and the next generation care analytics technology is the
accessibility and utility of clinical data from EMRs. As the market evolves to include more shared-risk
arrangements, stakeholders (providers) will rely on care management intervention to meet thresholds on
specific pay-for-performance measures. This will amplify the value of care management analytics that
enable proactive quality management. ACOs and similar organizations cannot expect success without
making wide and deep use of such IT tools.”
– Gartner Provider Hype Report 2012
- “By using near real-time patient health records from EMRs along with financial claims data, PSCI
presents patient risk analysis and population risk stratification along with causal factors to understand the
total cost & quality drivers associated with patient care across the patient population. By understanding
the drivers, physicians make interventions to have a dramatic impact to lower the healthcare cost curve.”
– Karen Kennedy, CEO – Medical Clinic of North Texas
- “BlueCross BlueShield has been running medical home pilots since 2010 with Village HealthPartners in
Plano and the 42 offices of the Medical Clinic of North Texas. The pilots improved care and saved an
average of $10.50 a month for 25,000 patients….”
– Dallas Morning News June 23, 2012