CMS just announced the shared savings generated for the last year, but Beatles ACO will not earn a penny. It couldn’t qualify for the shared savings payments. This was the second consecutive year without payments. Failing to provide Value-Based Care, Board was desperate to implement Population Health Management. So, they decided to make some changes in the management and elected John Doe as the new CEO of Beatles ACO. John is famous in Healthcare Industry for his innovative approaches and decision making.
John came on board and as the new acting CEO, he asked for any data that could help him understand the current working structure. He wanted to know the areas where Beatles ACO was lagging behind. He had no idea whether it was the whole network or some providers of selected regions who brought down the overall average. The IT team of Beatles ACO hands him over the claims data, which did not help understand one thing!
He talked to some of his friends in the industry and they asked him to try Datashop. He started reading about and finally decided to schedule a demo with the platform team. When the platform team arrived, John cut to the chase and straight away asked the burning questions.
“What can your platform tell me about my past performance? And most importantly how soon?”
Once you provide us the claims data, we will take 14-21 days to tell everything about the past performance of Beatles ACO. By everything we mean the following :
“Ok. So, does it help me in decision making?”
You can view the aggregate performance of the ACO and drill down to the lowest level. Just point and click on any measure and select any region to find out the performance there.
For instance, if you notice that south region hasn’t been performing well, you click on it and go deeper to see the performance of all the providers there and which provider is farthest from the benchmark scores. Even if that doesn’t help you go deeper and check out the physicians who are lagging behind.
Seeing the performance there, you can plan interventions accordingly for the provider facility. For example, if a provider facility lags in the Hba1c test for 12 months measure, you can intervene and help it improve on it.
“That’s nice, but could I expect more? What about my present performance? Can we improve on that as well?”
Of course, you can! There is a lot more you can do than just view the performance.For that, we need pre-adjudicated claims and once we have those, you can do:
“Wow! All this from claims data! Is there scope for any other advancement?”
Actually, this is just the beginning, there are limitless opportunities after this! We had claims data and we provided you with performance tips. Once we get clinical data we’ll do a lot more than just tips! It helps you in transitioning to Value-Based Care, embracing Population Health Management and a lot more.
What we do with the clinical data:
“You said Population Health Management. Do you have a mechanism for care coordination too?”
Yes, sir! As a matter of fact, we do! With the help of pre-built risk models, we assign a risk score to patients and track the high-risk patients. To illustrate:
John implemented the platform and within days the ACO transitioned to Value-Based Care. The Quality scores drastically improved and next year they not only met all the clauses in the contract but also generated a lot of savings.
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