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Results

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.

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.

Analytics Driven Improvement Efforts Reduces Surgical Supply Costs by $3.2M

Banner Health identified considerable variation in surgical supply use across its facilities. The health system desired a collaborative, data-driven strategy that would allow it to maintain high-quality outcomes while simultaneously decreasing costs across all procedures systemwide. To standardize supply use, Banner Health implemented an analytics application to help identify high-volume, high-cost surgical procedures that varied across the system. It then built standardized surgical preference cards for the high-volume procedures.

Featured Outcomes

  • $3.2M reduction in surgical supply costs for laparoscopic appendectomy, laparoscopic cholecystectomy, robotic assisted hysterectomy, and total hip and knee replacements, in just 15 months.

Engaging Providers to Transform Blood Transfusion Practices

Thibodaux Regional Health System sought to transform its blood transfusion practices. Aware that blood transfusions were often over-used, Thibodaux Regional’s leadership prioritized engaging providers to decrease unnecessary transfusions, reduce potential risks to patients, and improve costs of care. The organization leveraged data and analytics to better understand opportunities for improvement.

Featured Outcomes

  • $104K reduction in costs, the result of a 28.6 percent relative reduction in red blood cell transfusion.
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