Reducing risk to drive VBC success for ACOs

By Milliman MedInsight

17 August 2023

As value-base care (VBC) progresses, accountable care organizations (ACOs) face a significant challenge in balancing the quality of care and financial outcomes while taking on increasing financial risk. This task becomes even more difficult without a comprehensive understanding of patient populations and overall performance, making it challenging to sustain value-based care effectively.

ACOs typically have limited staff dedicated to data analysis, often lacking a chief actuary and relying on a CFO instead. Additionally, they lack experience in adjusting for risk and utilizing healthcare groupers effectively. These small teams also rely heavily on analytics modules of their electronic medical record (EMR) system, or they use a combination of Microsoft Excel and business intelligence (BI) software such as Power BI or Tableau.

To compound the situation, ACOs lack the financial safety net of a substantial reserve to cover risks like claims liability incurred but not reported (INBR) and others.

Achieving VBC with advanced analytics

Harnessing data and insights are key to effectively charting the path to value-based care. In fact, ACOs are increasingly adopting healthcare data analytics software, which allows them to rapidly aggregate, normalize, and contextualize claims and clinical data to provide a comprehensive view of their business.

By doing so, ACOs can improve their ability to enhance and evaluate patient populations, ensure the delivery of appropriate care, pinpoint areas for risk mitigation, and make necessary adjustments to their care delivery models in an efficient and effective manner.

How MedInsight value-based care analytics can help

MedInsight offers powerful data-driven insights through its Value-Based Care Platform. Built specifically to address the needs of ACOs, the MedInsight Value-Based Care Platform delivers timely, normalized, and contextualized insights and analytics that ACOs can trust and rely on to better serve patient populations. Our solution offering is specifically tailored to scale alongside the level of risk assumed by each ACO. This allows them to:

  • Effectively determine contract pricing
  • Pinpoint gaps in patient care
  • Enhance patient well-being
  • Qualify for quality incentives
  • Achieve desired financial outcomes

In other words, our solution is designed to align with the specific goals of each ACO, ensuring that they can adapt and succeed in their unique circumstances.

MedInsight VBC grows as provider risk increases

MedInsight VBC Grows as Provider Risk Increases

Alongside the core components of the Value-Based Care Platform, MedInsight VBC Insights and Analytics, collaborating with the MedInsight team guarantees access to a tailored solution mix. This mix can include analytic IP and methodologies widely adopted in the healthcare marketplace including Milliman Advanced Risk Adjuster (MARA), Chronic Condition Hierarchical Groups, Benchmarks, and Health Waste Calculator.

Moreover, the partnership ensures that the MedInsight platform is seamlessly implemented and customized according to your specific needs. Additionally, your team will receive comprehensive training to become proficient in utilizing this powerful system effectively.

Users of Epic will also appreciate that the core analytic methodologies that power the MedInsight VBC platform are integrated with the Value-Based Performance Module (VBPM) of Healthy Planet. MedInsight’s contextualized insights allow Epic customers to not only understand the drivers of financial and health risk, but also how to act in ways that will bring them closer to achieving their population health goals.

Contact a MedInsight analytics expert to learn more about our Value-Based Care Platform and how MedInsight can help your organization in its glidepath to risk.

Learn more about MedInsight VBC Analytics software