Quality/Cost Analysis

Reduce Total Cost Of Care And Improve Quality With Advanced Data Analytics

Successful value-based healthcare delivery is predicated on your capacity to improve the quality and reduce the total cost of care at the same time. Clinigence integrates quality data from electronic health records (EHRs) with cost data from claims to give you this capacity.

Cost/Utility Breakdown

Clinigence also provides out of the box canned reports that break down the total cost of care by practice and provider, based on (Medicare) enrollment type (disabled, aged dual, aged non-dual and ESRD,) major expense categories (Inpatient, outpatient, Part B/provider, skilled nursing facility, home health, hospice and durable medical equipment.) CMS-HCC risk adjustment scores are calculated for each population.

High Utilizer Reports

Additional “canned reports” include high utilizers of certain services, such as the emergency department and hospital services. You can easily identify high utilizers of any other service of interest as needed.

Cost/Quality Transparency Reports

Cost/quality transparency reports show the average cost/quality indicator by facility and/or by the provider as calculated for your patients. These reports help you assess the value delivered by providers outside your network to your patients. They provide the basis for value-based referral patterns and arrangements.

Ad-Hoc Reports

You can easily create additional reports based on virtually any cost or quality criteria. For example, you can pull up aggregate cost reports by diagnosis-related groups (DRGs,) hierarchical condition categories (HCCs,) diagnoses and procedures, etc.

Cost of Quality Reports

Clinigence is also developing unique “cost of quality reports” in collaboration with our ACO clients. These reports specifically measure the cost-effectiveness of clinical guidelines and protocols.

Quality and cost analysis for healthcare organizations

Quality-cost correlation. Each dot on this scatter graph represents a single practice within an ACO. The practices are measured on their average annual patient cost (risk adjusted) and an aggregate MSSP quality indicator. As the graph clearly shows there is an inverse correlation between quality and cost. Note that most practices are either in the “low quality/high cost” (red) quadrant or in the “high quality/low cost” (green) quadrant.

Quality and cost analysis for healthcare organizations

Cost/utility breakdown report by practice (rows), enrollment type and major expense categories (columns.) Notice that outliers (both high and low) can be easily identified and highlighted. You can also use this report to drill down to individual patients, episodes of care, clinical events and services.

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