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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.

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.

Using Analytics to Improve Clinical Coding

Responsible for coding approximately 380,000 episodes annually, clinical coders at Guy’s and St Thomas’ NHS Foundation Trust review documentation across several systems. The overwhelming amount of data, burdensome manual review processes, and limited coding resources made reviewing all data unfeasible. To address its coding challenges, Guy’s and St Thomas’ leveraged its data platform to combine and standardise data across disparate source systems. The organization now has access to data and technology that can be used to augment coders’ work, automating data gathering to better identify patients whose diagnostic coding could be improved.

Featured Outcomes

  • 800 patients with missing obesity diagnosis code identified in just one month, representing a value of £1.5M ($1.9M) annually.
  • 250 patients with AKI and/or CKD identified in just one month, representing a value of £100K ($130K) annually.
  • 50 patients with vitamin D deficiency identified in just one week, representing a value of £100K ($130K) annually.

Optimizing Space Utilization Improves Patient Access and Revenue

Texas Children’s Hospital had dramatically improved patient access, yet it recognized that it could advance access further by improving space utilization and proactively reallocating underutilized exam rooms. The organization developed a space visualization analytics application, and conducted a comprehensive space assessment, identifying opportunities to improve utilization of current space to increase clinic offerings—resulting in improved access for patients and families by utilizing space efficiently.

Featured Outcomes

  • $86K in additional revenue in just six months, the result of adding approximately 550 additional appointments.
  • Improved visibility of room demand and availability.
  • 20+ outpatient specialties actively using the space utilization analytics application.

Improved Patient Scheduling Enhances Care and Boosts Revenue by $8.3M

The amount of time a patient may have to wait for a scheduled appointment at Texas Children’s Hospital varied greatly as a result of a lack of standardized processes. After taking a deeper look at its scheduling process with the help of analytics, it was able to develop an improvement strategy aimed at improving access to care—enhancing patient care and boosting revenue.

Featured Outcomes

  • $8.3M increase in revenue, the result of adding more than 53,000 appointments annually.
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