ACO Explorer

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Product Overview

ACO Explorer is an executive-level dashboard for monitoring ACO health. Review trends and performance against targets on key metrics for per-member-per-month performance, leakage, and utilization. The performance dashboard will include ACO measure performance if the organization has deployed ACO Measures as well.

Features

  • Executive Dashboards feature trends and performance against targets for the following: 1) Per-member-per-month payments, 2) Leakage, 3) Utilization, 4) Quality (if the user also has the ACO Measures dashboard, then summary quality results are also available)

Benefits

Review information about trends and inconsistencies across at-risk contracts to start asking “why”

  • Monitor trends and performance against PMPM targets
  • Review performance on critical utilization metrics
  • Identify the highest areas of out-of-network service utilization

Quickly and easily assess the state of ACO health

  • Claims-based dashboard provides a view across the continuum of care
  • Monitor and compare performance across all at-risk contracts
  • Executive-level visualizations support a quick and easy assessment of overall performance

Faster time to value

  • Eliminate the burden of manually scrubbing and analyzing claims-based files
  • Ongoing claims-based files refreshed as quickly as 24 hours upon receipt
  • Easy-to-use executive, focused tool intended for users with little to no analytics background

Measures

PMPM

  • Trend of PMPM payments over time, across all at-risk contracts
  • Top 10 PMPM contribution, by specialty and principal diagnosis
  • Top 10 PMPM variance, by provider and principal diagnosis

Leakage

  • Trend of leakage over time, across all at-risk contracts
  • Leakage PMPM for the current and prior year
  • % of total dollars leaked, per contract

Utilization

  • Admits per 1000
  • ER Visits per 1000
  • Inpatient Days per 1000
  • Average Inpatient LOS
  • Rehab LOS
  • 30-Day Readmission Rate

Quality (if client also has ACO Measures)

  • Current percentile/measure
  • Current score and target/measure
  • Previous score
  • Monthly trend

See Sample Screenshots of ACO Explorer

Data Sources

  • Required: Paid claims for in-patients and out-patients plus associated membership and provider files.
  • Optional: If the client also has ACO Measures, summary level information will be displayed.

ACO Explorer: A Deeper View

Background

To succeed, ACO executives need to successfully manage costs and ensure that they meet key performance metrics. ACO Explorer provides a single, unified view of ACO performance on these financial and quality metrics so that leadership can quickly assess performance and identify problem areas across all at-risk contracts.

What types of problems does ACO Explorer address?

ACOs gain access to claims data to monitor their ACO performance, but may find it difficult to interpret and analyze it. Using ACO Explorer, users can quickly and easily analyze this claims data, gaining a window into current ACO health.

Use Cases

  • A health system enters a shared-savings agreement with a local payer, and wants to understand how it is performing against its per-member-per-month targets; using ACO Explorer, the executive team can quickly see that for the past three months PMPM payments trended below the target, but that there has been a worrisome rise in spend in the last month
  • The leadership team wants to quickly identify potential sources of rising PMPM rates; using ACO Explorer, the CFO notices that septicemia is the greatest contributor to overall PMPM rates, and organizes a team to identify potential improvement opportunities

Anticipated Improvements

  • Quickly and easily assess the state of ACO health by monitoring and comparing performance across all at-risk contracts.
  • Eliminate the burden of manually scrubbing and analyzing claims-based files. On-going files refreshed as quickly as 24 hours after receipt.
  • Review PMPM, utilization and quality measure trends to identify potential problem areas and focus further evaluation and improvement work.

Success Measure Examples

Opportunity Identification:

  • Quickly identify trends across all payer contracts
  • Identify the top contributors to PMPM performance, positive and negative
  • Monitor key utilization metrics and trends