CMS is pushing providers to shift to value-based care delivery and payment models through rewards and penalties based on performance. 90% of payers and 81% of hospitals now offer a mix of fee-for-service and other reimbursement models and by 2020 it is anticipated that two-thirds of payment will be based on complex reimbursement models with underlying value measures.

These new payment models leave providers with a higher degree of risk burden for patient care and the need to drive greater patient engagement. To succeed in this new risk-taking business, providers must focus on population health initiatives in order to understand their populations based on cost and quality and also be able to forecast the risk of high cost and high levels of care amongst the patients they serve.

In order to stay financially viable in the shared savings scenario, risk-taking businesses need to have transparency into where the greatest opportunity for impact lies related to over- utilization of resources, disease management and cost containment, all while maintaining high quality of patient care.

Industry Challenges:

  • Increasing complex populations (chronic condition management)
  • Ensuring accurate payments from payers
  • Meeting quality requirements and closing care gaps
  • Low patient engagement
  • Value-based care and contract performance
  • Reducing care variation between providers
  • Achieving population health management by understanding and stratifying patients through the lens of cost and quality, risk, and utilization measures
  • Accurate documentation of diagnosis codes used in risk adjustment and quality measures.

Serving provider organizations looking to proactively manage risk, improve quality outcomes and optimize network performance.

Using Actions to Create Insights That Improve Outcomes

Using Actions to Create Insights That Improve Outcomes

On-demand Webinar

Managing Population Risk: Industry Insights Reveal Key Strategies

Held on: June 7, 2018

Watch Video

Solution Offering:

Depending on where you are on your value-based care journey, SCIO helps improve outcomes in the most impactful areas of your business. Our approach centers around delivering insights that fuel data-driven decisions in the following key areas – areas in which prove to deliver the greatest impact on population health and value-based outcomes.

  • Quality & Compliance
    • Proactively and effectively manage care gaps, chronic conditions and population health. Use predictive, prescriptive and behavioral analytics to understand where and how to focus limited resources for improved clinical and financial outcomes.
    • Improve quality measure compliance across the provider network. Quickly see the providers meeting quality metrics and where opportunities exist to improve compliance (HEDIS, Stars, P4P, etc.) across providers.
  • Optimizing Risk & Revenue
    • Proactively manage population risk. Go beyond traditional risk stratification by using advanced predictive and prescriptive analytics to identify actionable care gaps and design performance-based programs based on which ones represent the biggest opportunity to impact cost and quality measures.
    • Optimize revenue potential. Improve RAF scores, reduce coding and documentation errors and gain a clear line of sight into expected and actual CMS payments.
  • Provider Network Management
    • Improve provider network performance. Gain a clear line of sight into the performance across your network by tracking, monitoring and predicting efficiency trends, cost drivers, network leakage, etc.
  • SCIO takes an outcomes focused approach to delivering insights as a service to our clients. SCIOXpert® consultants work with your organization to understand your needs and collaborate to determine the best path forward. Our insights-as-a-service delivery model can be augmented with any of SCIO’s innovative analytics technology platforms if desired.