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ACOs / Care Management
Industry-leading solution enabling ACOs to achieve superior clinical and financial effectiveness.
Faster, reliable and cost effective analytics solution to meet the "triple-aim" of ACO's and organizations that work with ACOs (e.g.: health plans, PBMs, and care organizations) to manage total care, quality and efficiencies.
SCIO®’s end-to-end ACO analytics solution offers a scalable data and analytics framework that reduces ACO set-up and operational overhead, and creates transparency and predictability across the care continuum leading to utmost clinical and financial effectiveness.
Our proven data management capabilities and industry-leading risk analytics enable ACOs to meet the "triple-aim" of lowering costs, improving population health and member satisfaction. Using our analytics solution, ACOs can proactively identify high risk members, develop care coordination mechanisms, manage risk, and more importantly drive member engagement and compliance.
Why SCIO Health Analytics?
- Proven experience in risk management and predictive modeling
- Credibility and reputation in the health payer market with respect to clinical and financial outcomes measurement
- Ability to integrate data from multiple and disparate sources including EMR, lab, medical charts etc
- Capability to offer end-to-end cost effective solutions
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Our suite of solutions:
Opportunity Analysis
Assess and formulate care management strategies that offer the best ROI for ACOs including the care areas of focus and related quality and outcomes measures
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Data Integration and Management
- Fully integrate data from disparate sources including, but not limited to, medical claims, pharmacy claims, eligibility/enrollment, EMRs, paper-based medical charts, lab results and hospital-based data.
- Create a unified member profile that is accessible across the care continuum and transferrable to the electronic systems, maintained either by the ACOs or the third-party vendors (e.g. wellness, nurse-line, dm) that support the ACOs
Risk Identification and Stratification
- On an on-going basis, identify members who are at-risk for hospitalizations, re-admissions and high cost preference sensitive treatments
- Identify pockets of opportunities to reduce costs and improve health outcomes by directing members to appropriate preventive care or alternate services
- Offer the right members the right care at the right time by associating member health risk with member compliance, gaps in care and behavioral patterns, and historical engagement.
Quality Measurement and Reporting
- Monitor and report member-level as well as population-level quality, cost, utilization and member satisfaction measures
- Monitor and report risk-adjusted provider quality and efficiency measures to bring visibility into provider performance and identify areas of improvement
Payment Analytics
Apply payment reconciliation processes to support reimbursement models such as gain and risk sharing, bundled/episodic, and full capitation
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