ACOs & Risk-Bearing Delivery Organizations
Let your clinical & cost data lead the way
Integrate Clinical & Cost Data
Managing risk based on retrospective claims data alone is as risky as driving your car by looking only at your rear view mirror:
Clinigence provides real-time integration of your clinical (EHR) and other patient data sources to give you a real picture of your patients’ needs and the care gaps you can address today to prevent them for unnecessary cost and utilization tomorrow.
Analyze Data to Identify Savings Opportunites
Cost and Utilization Analytics help define your top target populations for reducing the total cost of care.
Improve Clinical Quality to Maximize Savings
Clinical quality improvement requires changing behavior. Clinicians must learn to adapt to new workflows, care processes and protocols. And patients often need to learn to adhere to new care plans that involve lifestyle changes in order to improve outcomes. While behavior change is always a challenge, comprehensive, real-time patient data provides a powerful guide for the journey as illustrated in the sample report from one of our ACO customers below. Read more on the 3 steps to successful clinical quality improvement.
Report to Payers
As a Medicare ACO, you are required to collect and report clinical quality data annually. Some commercial ACO arrangements include similar requirements. If most of your clinical patient data is already electronic, there is no reason to waste your staff’s time on data collection and reporting. Let your staff focus on what matters most: improving the quality of care for your patients. And let us automate the tedious processes of chart abstraction, data collection and report submission. Since 2012, Clinigence has helped many ACOs successfully comply with Medicare and commercial payers’ reporting requirements at a fraction of the cost and hassle associated with this process.
Leverage Fee-For-Service Opportunities
Many activities promoted under value-based payment are also reimbursable under current fee-for-service (FFS) models. Since value-based models, such as shared savings, often offer only deferred reimbursement, you may find it especially beneficial to leverage any opportunity to increase revenue in the short-term while building your capacity to take on risk and deliver value in the future. Among these opportunities:
Annual wellness visits (AWVs) - not only does Medicare pay for these visits, but they also provide an excellent opportunity to ensure that:
Your healthiest patients remain attributed to your ACO.
Potential problems, such as fall risk, depression, cancer, etc. are identified early.
Care gaps are prevented or addressed early benefiting your patient health and your quality performance.
Closing gaps in care
Preventing network “leakage” - making sure patients stay within your ACO provider network.
Clinigence identifies and intelligently stratifies your patients in need of service - ensuring they get better care while you secure the associated add-on revenue.