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Population Health Analytics Enables Improved Quality Increasing Revenue by Nearly $1M

Advanced payment models incentivize Accountable Care Organizations (ACOs) to deliver high-quality care and close gaps in care for members, thereby earning shared savings and increasing profits. However, in order to succeed and identify gaps in care, ACOs must be able to rely on solid data and analytics to avoid losing income that could be invested back into patient care. Utilizing its analytics platform and a quality measures solution has allowed Hospital Sisters Health System to close care gaps, improve ACO quality measures performance, and enhance reporting accuracy and effectiveness.

Featured Outcomes

  • Nearly $1M in revenue from the Medicare Shared Savings Program over two years.
  • 11 different quality measures improved in just one year.
  • $320K in savings, the result of eliminating third-party quality reporting software.

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.

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.

Prioritizing Outreach for Care Coordination Amid the COVID-19 Pandemic

OneCare Vermont sought to identify which of its patients were at the highest risk of serious illness or mortality from COVID-19 and which of its patients with chronic healthcare problems needed care for medical issues other than COVID-19. Leveraging its data platform, OneCare Vermont enabled rapid identification of at-risk patients. Providers and care teams use the risk-stratification care coordination tool to proactively conduct patient outreach, including telephone calls and telemedicine virtual visits, ensuring patients receive needed social support and medical care during the pandemic.

Featured Outcomes

  • Just three weeks after the governor of Vermont declared a state of emergency, released a COVID-19 care coordination tool, applying the risk criteria to approximately 190K patients.
  • More than 500 cumulative sessions logged in the application across OneCare Vermont’s network.
  • Indicators of social complexity were included in the tool.

Millions Saved: Complex Care Coordination Reduces Total Cost of Care

OneCare Vermont, an accountable care organization (ACO), is focused on reducing costs by reforming payment models. As the organization methodically and rapidly moves toward value-based payments, it is challenging current delivery methods and seeking to engage providers and patients in new care models. To be successful, OneCare needed to implement strategies to effectively drive change. With robust data analytics, it was able to prioritize opportunities for improvement and ultimately change the way care is coordinated and delivered throughout its network. Results include nearly $20M in positive, value-based financial results in just one year.

Featured Outcomes

  • $13.3M lower Medicare total cost of care than the expected/contracted total cost of care.
  • $6.12M in favorable Medicaid fixed payments.
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