Key Highlights
- Increased cost savings and budget surplus
- Strengthened provider trust
- Improved efficiency
- Enhanced attribution capability and benchmarking for better financial performance in VBC contracts
- Improved collaboration among care teams
With a population of over 250,000 lives spanning eight hospitals and nearly two dozen counties, a Northwest-based clinically and financially integrated network (CFIN) wanted to take the next step in its evolution as a pioneering driver of value-based care (VBC).
With a business model incorporating partnerships with both commercial and public health plans and a commitment to high quality, cost-effective healthcare including an ambitious public health strategy, the CFIN needed an analytics solution that provided transparent and reliable data across its clinical, business, and contracting sectors to ensure the alignment of VBC incentives and goals.
Challenge
Fragmented data
With the shift to an expanded model of value-based care, network leaders recognized the risk of fragmented data siloes threatening their ability to identify sources of leakage and opportunities for improving the delivery and cost-effectiveness of care across a geographically isolated population.
To drive trust in its ability to provide exceptional, patient-centered care while moving to a risk-based contract model, the organization needed an analytics partner that could deliver a single-source-of-truth for supporting patient health across the care continuum, and aligning clinical, business and compensation goals.
Strained resources, intense competition and provider doubts
As the organization worked to tackle its value-based care goals in the face of escalating costs and an increasingly competitive marketplace, it needed to close gaps in system interoperability, and improve its ability to manage strained resources. As an added challenge, the organization faced the task of having to rebuild the trust of its 4,000+ participating providers in the measures used to evaluate their performance after a poor experience with a prior analytic vendor whose opaque metrics had undermined provider buy-in.
Population health data gaps
The organization needed access to reliable analytics for insights into the social determinants of health (SDoH) to support its role in ensuring high-quality patient care and improved community health. To improve the quality of care and advance its population health strategies, the organization needed a holistic analytic framework that would enable data-driven decision making for closing care gaps, ensuring appropriate utilization, and ensuring a thorough knowledge of its member healthcare needs.
Action
The organization turned to Milliman MedInsight for an analytics solution that could support the transition to value-based care. MedInsight’s “fundamentally better understanding of the data” was a deciding factor in the organization’s choice, according to its vice president of operations. Other factors included MedInsight’s transparency, groupers and “ability to ingest and transform data.”
MedInsight VBC Platform
The MedInsight VBC Platform was chosen for its ability to organize value-based care analytics into a transparent, scalable, and collaborative solution for a deeper understanding of the population and visibility into opportunities to close care gaps, improve provider engagement and promote efficient utilization.
Robust analytics
Scalable, robust analytics and MedInsight performance benchmarking were critical to the organization’s ability to improve cost, quality and efficiency, and restore provider trust. Improved benchmarking and utilization management capabilities included a reliable system of attribution and tools like Health Cost Guidelines groupers, the Health Waste Calculator, MARA risk scores and more.
No black box approaches
Fully transparent methodologies helped ensure both a deeper understanding of the data and ensure trust in provider performance analytics.
Results
Strengthened provider engagement
By leveraging its improved analytic capability for a single source of truth, the organization was able to leverage the trust and collaboration of its providers for improved quality and coordination of care, cost savings, and the ability to advance its value-based care transition.
Improved VBC contract financial performance
Efficiency in key areas including data analytics, benchmarking, utilization, care coordination, provider and patient engagement, and technology and data integration resulted in better financial performance for value-based care contracts. The result was increased speed-to-value driven by a holistic analytics framework.
Cost savings and strategic gains
Insights identified by using the MedInsight VBC Platform led to more effective collaboration, quality improvement and innovation, and cost savings. The organization was able to leverage its improved analytic capabilities to expand its efforts in areas including senior care, chronic condition management and the launch of its own health plan. And in a highly competitive marketplace, the organization has repeatedly generated a surplus that is shared with participating providers.
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