Project Description
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Identify Savings Opportunities
Actionable Information at Your Fingertips
The Clinigence Value Improvement Platform® (VIP) Cost Package leverages medical claims from payers to empower your organizational change initiatives on the road to value-based healthcare. You may want to take a moment to familiarize yourself with the Clinigence Organizational Change Framework before reading this page. This simple and practical framework consists of three steps:

See
Visualize the Need for Change

Move
Make Changes

Finish
Follow Through
See Savings Opportunities
Clinigence leverages claims data to predict how much your organization can save in different areas, including:
Emergency Department (ED) Superusers. Avoidable ED Visits. Hospital Readmissions. Inpatient Complications. Choosing Wisely Guidelines. Click on any of the bars on the chart to see savings breakdown by providers and other criteria.

ED Super Users

Breakdown by PCP (top left) and patient (top right) enable you to demonstrate the need to address the issue and empower clinicians with the information they need to effectively address the needs of ED Super Users.
Avoidable ED Visits

Breakdown by ED facility (center left) and PCP (center right) help inform your decision on where access to other care options may be lacking.
Hospital Readmissions

Breakdown by hospitals (center left) and PCPs (center right) help prioritize interventions.
Inpatient Complications

Breakdown by complication type (center left), provider (bottom left), and specialty (center right) enables pinpointing the root causes of inpatient complications.
Choosing Wisely Guidelines

Breakdown by PCP (left), service category and type (center top), procedure group (center bottom), and individual procedure (right) helps choose and prioritize the most effective interventions.
Manage Variance to Move
Variation in performance often makes for a powerful tool in driving organizational performance improvement. Visualizing the differences in outcomes among peers can push underperformers to see the need to improve and begin to move. Recognizing top performers is always a motivator for them to finish the good work they've been doing. Perhaps most importantly, creating a collaborative environment enables everybody to learn from one another's experience and adopt best practices that have been proven to lead to better outcomes.
Click on any of the highlighted areas on the screenshot to learn more about how to leverage performance variance to get the organization moving in the right direction.
PCP Cost Variance Analysis
Each PCP is represented by a blue dot on the scatter graph. The X (horizontal) axis shows the average risk for the provider's panel. The Y (vertical) axis shows the average normalized cost per patient (higher values represent lower cost).

average performers
Providers in this zone can benefit from ongoing education and sharing best practices.
Track Progress to Finish
Once you've set a goal and got the organization moving towards it, you must continuously track performance to ensure progress. Organizational change does not happen overnight. Progress is hardly ever consistent over time. By tracking performance as closely as possible to real-time you can tell when progress is slowed down or even derailed. A quick analysis of root causes and early intervention to adjust course as needed provide the best bet for making it to the finish line, i.e. achieving your goal.

See Cost Drivers by Condition
Clinigence helps you see what's driving the cost of care of a population from a diagnostic perspective. You can then prioritize your resources and direct your interventions and programs accordingly. You can also see a breakdown of cost by place of service and provider specialty - either across your entire population or by selecting a subpopulation by any condition.

Leverage Clusters to Move
Predictive cost models often use diagnostic groupings or clusters. Understanding how a population is split into such clusters and their impact on predicted cost can help you move more accurately and effectively with targeted clinical interventions and programs. You can also see how well individual providers manage specific conditions in order to help them move to improve performance.

Finish where It All Starts
Population Health starts with individual patients. Clinigence enables you to drill down quickly from your target population to those individual patients predicted to benefit most from additional care coordination. You can also quickly see what clinical indications are projected to have the most impact on an individual patient's predicted cost.

See Complication Rate by Provider
Clinigence helps you see complications by type, specialty, and provider. You can then help individual providers see the need to improve quality. You can also easily equip them with the information necessary for them to move towards preventing complications by discussing specific complication cases.
Leverage Transparency to Move
Comparing quality among providers is a powerful tool for you to move towards improvement. For example, Clinigence reveals readmission rates for all the hospitals in your community. For hospitals within your network, you can use this information to help specific providers see the need to improve and empower them with the data they need to move towards readmission reduction. You can also leverage this information in your discussions with out-of-network hospitals and get patients to move towards higher quality facilities.
A Culture of Quality to Finish
Quality improvement is a never-ending process. To "finish" the job, you must create an organizational culture centered around quality improvement. This means a culture of continuous measurement, learning and commitment to change. It also means that part of your role is to lead the organization to adopt quality guidelines. One specific set of such guidelines is provided by the Choosing Wisely initiative. Clinigence has implemented many of these guidelines to help you promote conversations about quality between patients and providers.
See Staff's Performance
Clinigence helps you see how well each practice or individual provider is performing overall, in specific areas, such as cost, utilization, quality, prevention, etc., and on specific performance indicators. You can rank peers based on their scores. But before you share such ranking with them you'd better take a close look at their respective patient risk profiles. Underperformers will be quick to claim that their patients are sicker. Clinigence equips you with each provider's risk score so that you can effectively address such claims.
Track Progress to Finish
As providers engage in performance improvement, you can support their efforts by setting goals and tracking their progress to the "finish line." Clinigence also reveals as closely as possible to real-time any slowdown or derailment of progress. A quick analysis of root causes and early intervention to adjust course as needed provide the best bet for making it to the finish line, i.e. helping providers achieve the goals set for them.
See the Full Picture
Clinigence helps you quickly see the full picture of each patient. The Patient Summary Dashboard includes:
A breakdown of cost by provider, place of service, provider type, and specialty. A breakdown of claims by primary diagnosis. All procedures and their costs. All hospital revenue codes.
Leverage Individual Needs to Move
You can use personal health indicators to engage patients in their health. Clinigence provides you with a quick view of the patient's clinical markers and their predicted impact on future service utilization. For example, sharing with a patient the probability of her hospitalization in the next 6 or 12 months can help make her see the need to move forward with her care plan.
Track Individual Progress to Finish
In addition to checking in directly with the patient, Clinigence helps you track their compliance with care plans. For example, you can monitor patient adherence to prescriptions by looking at their refill patterns for all medications (see screenshot). Similarly, you always have access to comprehensive care gap reports.
See How Network Providers Compare
Clinigence helps you quickly see how different providers in your community perform relative to their peers. You can compare hospitals, skilled nursing facilities (SNFs), home health agencies, specialists, etc. Clinigence reveals both cost and quality performance indicators, such as average length of stay (ALOS), average admission cost ("paid/admit"), etc. You can also see how each provider is trending on any of these indicators.
Finish by Tracking Leakage
In addition to checking in directly with the patient, Clinigence helps you track their compliance with care plans. For example, you can monitor patient adherence to prescriptions by looking at their refill patterns for all medications (see screenshot). Similarly, you always have access to comprehensive care gap reports.
Build Your Own Reports
The Clinigence Cost & Utilization Dashboard is fully customizable. You can build your own reports, share them across the organization, and even across our user community. While Clinigence continues to develop new and enhanced reports, we know that each organization is different and may have different needs. We also acknowledge the innovation of our customers and encourage them to collaborate among themselves and help us make our solutions better for all.
The gallery below shows some of the dashboards developed in collaboration with our partners and customers.