Proactively Manage the Performance Measurement Capabilities for Value-Based Contracts

Hospitals, health networks, and other care providers face many challenges associated with the shift to value-based business models.

The Care Insights Application, part of the Omni-HealthData suite, supports the analysis of populations, care management clinical and financial outcomes, provider performance, payer contract performance, quality, and cost on a rolling 12-month view. It allows clinically integrated networks to manage the quality and cost effectiveness of the care they deliver and manage to desired clinical and financial outcomes.

Care Insights

Features

Care Insights provides analytical insights to address the following areas:

  • Ambulatory Quality Measure Performance Analysis
  • Utilization and Cost Performance
  • Care Gap Reporting
  • Chronic Disease Prevalence
  • ED Frequent Utilizers
  • High-Cost Pharmaceuticals
  • Generic Prescribing Ratio
  • Opioid Utilization
  • Prediction of Avoidable Utilization
  • Preventable ED Visits and Admissions/Readmissions
  • Ambulatory-Sensitive Conditions
  • Financial Management of Shared Risk/Shared Savings Programs
  • Provider Peer Comparisons

Capabilities

Care Insights enables providers to proactively identify and prioritize opportunities to improve patient care and revenue by providing:

  • Benchmark quality, utilization, and cost performance
  • Risk-stratify patients on a variety of dimensions
  • Measure performance for episodes of care
  • Apply predictive models to proactively identify opportunities for cost reduction and/or quality improvements

Benefits

Care Insights will help to identify areas for improvement, monitor improvement efforts and demonstrate clinical performance to payers. Specific areas for improvement are:

  • Improve care quality by closing care gaps
  • Reduce unnecessary utilization (e.g. reduce lab tests and radiology studies that are not clinically indicated)
  • Generic substitution for higher cost medications
  • Reduce ambulatory sensitive ED utilization by engaging patients in primary care
  • Reduce readmissions through improved care transition

Value-Based Care executives need to negotiate and manage contracts that contain performance incentives and shared savings based on the achievement of quality, utilization, and cost targets. Care Insights is used to:

  • Model the baseline performance period for a payer population
  • Monitor performance for contract periods
  • Proactively identify areas of performance risk
  • Forecast financial result (e.g. incent and shared savings payments)
  • Report all metrics and measures in a rolling 12-month view

Audience

  • Network Director
  • Vice President Clinical Integration
  • Clinical Council
  • Utilization Council
  • Quality Control
  • Chief Quality Officer
  • Physicians
  • Practice Specialty Chairs
  • Clinical Analysts
  • Contracting

Data Sources

  • EMR Data
  • Inpatient, Outpatient and Ambulatory Billing Records (encounter data)
  • Medical and Pharmacy Claims Data
  • Patient Experience Survey Data
  • Population Based Benchmarks From Third-Party Providers
  • Quality Measure Code Sets
  • Medical Ontologies for Code Mapping

Find Out More

Health organizations can use the Care Insights Application to report all metrics and measures in a rolling 12 –month view. To demo this app of to get more information, contact us at 800-969-INFO or fill out this form.