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Denials Management Analytics Reduces Denials by Nearly $5M

On average, claim denials cost each healthcare provider $5 million every year. This loss of revenue resulting from claim denials is a concern for healthcare providers. Billings Clinic sought to determine the cause of claim denials and realized that it needed an analytics solution that could integrate data from multiple sources. The health system leveraged its data platform and analytics applications to pinpoint the sources of the denials, allowing the organization to implement prevention plans and procedures for recovering the denials. Billings Clinic achieved significant results, including:

Featured Outcomes

  • $4.5M reduction in denials in just 12 months, the result of an eight percent relative reduction in overall denial dollars.

Analytics and Provider Operations Support Generates Nearly $2M in Shared Savings

Acuitas Health was challenged to identify opportunities for shared savings, reducing cost while also improving quality outcomes. Using Acuitas Health’s advanced analytics, providers and payers can now connect, communicate, and share insights that enable the organizations to identify opportunities to decrease costs for all partners, and increase outcomes that yield benefits in several areas, including quality improvement, claims optimization, and risk adjustment.

Featured Outcomes

  • Nearly $2M in shared savings in just one year.
  • Six percent increase in Medicare hierarchical condition category (HCC) risk scores.
  • Nearly a 70 percent reduction in the time required to complete pre-visit planning in the first week after implementation.

Using Analytics to Automate Heart Failure Data Aggregation

For each heart failure admission, registered nurses at Guy’s and St Thomas’ NHS Foundation Trust collected data from five different sources, and then filled out a 10-page form for each patient. Information from the forms was then manually entered into the National Institute for Cardiovascular Outcomes Research (NICOR) web portal. This manual process for data collection and reporting was not only time-consuming and resource-intensive—but was also highly susceptible to error. To address these challenges, the organization leveraged the Health Catalyst® Data Operating System (DOS™) to integrate the data from the five source systems and extract data for nearly all of the elements required for heart failure readmissions—streamlining the NICOR submission process and improving data quality and accuracy.

Featured Outcomes

  • 50 percent reduction in the time required to complete the NICOR audit, saving more than 400 hours annually.
  • 52 extra days that registered nurses can spend seeing patients each year, rather than performing manual data entry.

Analytics Reveal AAA Programme Improvement Success

As part of its efforts to improve the timeliness of care for patients undergoing abdominal aortic aneurysm (AAA) repair, Guy’s and St Thomas’ NHS Foundation Trust needed to collect data to guide care redesign, help assess the impact of specific interventions, and gauge progress toward desired outcomes. Guy’s and St Thomas’ implemented the Health Catalyst® Data Operating System (DOS™) platform, including a Referral Pathway analytics application, allowing the organization to aggregate and standardize data across source systems. Improved data and analytics have enabled Guy’s and St Thomas’ to analyze, evaluate, and monitor outcomes for the entire AAA cohort and evaluate operational performance and associated patient outcomes.

Featured Outcomes

  • 880x more patients reviewed than in the previous year’s chart audit.
  • 30 percent relative reduction in time from referral to procedure for all vascular referrals.

Analytics Enables Value-Based Care Transformation

UC San Diego Health sought to transform its organization, expanding beyond fee-for-service, transitioning to value-based care, and improving the health of its patient population—forming its Medicare Shared Savings Program (MSSP) ACO. It realized it needed a better understanding of its organizational strengths, opportunities for improvement, and needed actionable, timely data that would enable it to improve outcomes, reduce waste, and succeed in value-based care. The organization leveraged an analytics platform to give insight into performance and improvement opportunities, educating and engaging ACO providers.

Featured Outcomes

  • $883K in cost avoidance, the result of a reduction in per member per month.
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