Value-Based Care (VBC) over the past few years has polarized most provider/payer businesses in US healthcare with risk-based reimbursement models. While there is a possibility of handsome gains, it is offset by the potential threat to their bottom-line and hence, existence. The road to VBC success has the milestones of care quality, cost management, patient/member engagement, provider satisfaction and preventive care.

These milestones rest on the foundation of clarity of vision and visibility into operations. Most provider/payer organizations struggling with the latter, suffer from a technology vacuum apparent through the following.

Your Challenges

Provider Network / Member Churn

Effective Provider Contract Management

Fluctuating Provider Utilization

Rising PMPM Spends/Cost

Referral/Network Leakage

Fraud Waste & Abuse

Poor PHM Programs’ Performance

Low Patient & Member Satisfaction

360° View of Patients / Members Missing

Regulatory Compliance Needs

Accuracy of Clinical & Admin Documentation

Efficacy of Case / Utilization Reviews

Gaps in Care and Coordination

Ineffective Allocation of Resources

No Insights into Patient / Member Health-Risk

Ineffective Patient / Member Outreach

Lack of Single Source of Truth

Poor Data Quality

No Concept of Reliable Master Data Exists

Inability to Slice/Analyze Data at Great Depths

Sluggish Decision Making

Redundant and Expensive Reporting

Missing/Questionable Data Governance

Limited Ad-Hoc Reporting

While there are other variables in the equation, technology infrastructure to harness data is the kryptonite for most VBC challenges.

Benefits You Can Reap

While data by itself might be an albatross around the neck, when leveraged tactfully, it can be the lighthouse for your decisions. Harnessing modern healthcare data analytics tool-set, inefficiencies in operations can be identified to impact business KPIs positively in areas such as (but not limited to) the following.

Quality of Care
  • Lower Readmissions (HRRP)
  • Optimized Length of Stay
  • Medication and Care Adherence
  • Evidence Based Care
  • Reduced HACs- CLASBI, CAUTI, Sepsis etc.
  • Factor SDoH for Better Health Outcomes
Cost of Care
  • Reduced PMPM Spend
  • Operational Cost Efficiency
  • RCM Optimization
  • Improved Auto Adjudication Rate
  • Minimized ED 'Frequent Flyers'
  • Optimized Policy Administration
Patient/Member Experience
  • Personalized Communication
  • Reduced Member Churn
  • Social Activation
  • Immersive Engagement
  • Improved (H)CAPHS Scores
  • Member Engagement in Care Programs
Provider/Payers
  • Reduced Eligibility Gap Errors
  • Better Utilization Management
  • Efficient Contract Negotiation
  • Disease Surveillance and Prevention
  • Reduced Member’s/Patient’s no Shows
  • Precision Medicine
Population Health
  • Robust Program Discovery for Members
  • Improved Care Programs Adherence
  • Proactive Care Intervention
  • Remote Member Monitoring/Support
  • Reduced Health Risk (via AWV,ARA)
  • Risk Ccoring for Preventive Care Programs
Regulatory Compliance
  • MMP/RAC Audit Preparedness
  • ACA, State and CMS Reporting
  • CQMs, HEDIS, Registry, Star Ratings etc.
  • Payer & Provider Performance Scorecard
  • PMPM, MLR, Enrolment, Utilization Trends
  • Custom Extracts, BI & Analytics
Do more with the insightful patterns in your healthcare data.

How We Can Help

Collection
  • Integration with data sources
  • Data profiling
  • Rule-driven transformations
Cleansing
  • Data quality management
  • Identity management
  • Standardize terminology, vocabulary
Organizing
  • Master data management
  • Data modeling
  • EDW, cubes, marts, data lake
Controlling
  • Establish policies and procedures
  • Metadata discipline through stewardship
  • Security, storage and archival
Harnessing
  • Report rationalization
  • Deductive, predictive analytics
  • Visualization (Self-service BI)
Maximizing
  • Reporting to public registries
  • FHIR endpoints for the ecosystem
  • 'Hooking' actions to insights

Let’s power your business with actionable data

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