Project Description

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:


Visualize the Need for Change


Make Changes


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.

Savings Opportunities
ED Super Users Avoidable ED Visits Hospital Readmissions Inpatient Complications Choosing Wisely Guidelines

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).

PCP Cost Variance Analysis
average performers

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.

Leverage Scorecards to Move

One of the most powerful tools to get staff to see the need for improvement is by sharing individual scorecards. Clinigence offers provider scorecards that further empower providers to move by highlighting areas of deficiency relative to peers.

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.

Move to a More Efficient Network

Using the comparative effectiveness reports you can define and build a more efficient provider network. You can then share this information with your primary care providers (PCPs) to move referrals towards "in-network" providers.

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.