Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

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the greatest challenge to ACO success is the misunderstandings created by the language we use. Baselining is a critical step to ensuring that both providers and payers are pulling in the same direction:
• What are the provider's patient population(s)?
• What criteria are we using to measure quality?
• What does “cost” mean? What is included in a service "cost”?
Once baselines are established, it’s critical that both providers and payers are monitoring these metrics regularly, so when gaps appear – which they will – adjustments can be made.

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Bridging the Gap: Bridging the Gap: Reaching Consensus on ACO Metrics

  1. 1. Let’s Talk Healthcare with Informatica and Edgewater: Bridging the Gap: Reaching Consensus on ACO Metrics Special guest: Senthil Balasubramanian, Manager, Decision Support, Penn Medicine Richard Cramer Maury DePalo Michelle Blackmer Chief Healthcare Strategist Director, Healthcare Practice Director, Healthcare Product Marketing Informatica Edgewater Informatica1
  2. 2. Today’s Agenda• Bridging the Gap – Achieving Better Data Alignment • Bringing Together Quality & Financial Data• Success Factors • Aligning Quality & Financial Objectives • Targeting Defined Patient Populations • Reaching Consensus on Baseline Medical Expenditures• Use Cases • Combining Financial and Quality Performance Analytics • Promoting Accountability across a Shared Process Model• Q&A 2
  3. 3. Use Case 1: Reporting & Analytics Integrating Quality & Financial Performance & Risk ManagementBy Practice Area, By Physician Specialty Care: Dr. Rubenstein Primary Care: Dr. Jamieson Cardiology Associates, Inc. Primary Care, Inc. By Service Types PMPM / Utilization / Adherence to Std / Clinical Risk / Financial Risk Inpatient DOS Procedure Submit Amt Paid Amt Outpatient Claim Nbr: 2006-1001-00101 3/30/2006 CPT 77057 3/30/2006 CPT 88174 Claim Total Screening Mammography, Bilateral ... Cytopathology (Liquid-Based) $ $ $ 105.00 45.00 150.00 $ $ $ 95.00 55.00 150.00 Claim Nbr: 2007-1310-00322 5/19/2007 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 5/19/2007 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 55.00 Claim Total $ 150.00 $ 150.00 Claim Nbr: 2009-1561-00451 7/30/2009 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 7/30/2009 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 45.00 Claim Total $ 150.00 $ 140.00 Claim Nbr: 2010-1833-00729 12/10/2010 CPT 88174 Cytopathology (Liquid-Based) $ 45.00 $ 45.00 12/19/2010 CPT 77057 Screening Mammography, Bilateral ... $ 105.00 $ 95.00 Professional Fees Claim Total $ 150.00 $ 140.00 Normative Data Provider Radiology Specification Patient Specification Provider Peer Group Service Laboratory Specification ? Provider A Result A Location Specification Provider B Result B Other Specification Provider C Result C Provider D Result D  Year over Year, Quarterly, Monthly Performance Tracking By Time Frame 3
  4. 4. Use Case 1: Reporting & Analytics Integrating Quality & Financial Performance & Risk Management Technology Solutions & Benefits Data Integration Core Data Models Population ModelsMaster Data Management • Primary Entity Reporting • Segmentation • Patients, Providers • Patient Cohorts • Charges, Costs, • Stratification Criteria PaymentsData Quality Management • Continuum of Care • Partnerships Models & Analytics • Gain / Loss / Risk Sharing • Care Records: • Incentive AlignmentReal-Time Events, Alerts Diagnoses, Treatments, • Inter-Enterprise Data & Decision Support Outcomes Architecture Information Lifecycle Process Models Business Models Management 4
  5. 5. Use Case 2: Patient & Physician Attribution Collaborative, Patient-Centered Care Primary Hospital Care Groups Specialty SNF, LTC Groups Physical Rehab Therapy PayersShared Accountability – Shared Risks & Rewards – Coordinated Delivery Platform 5
  6. 6. Use Case 2: Patient & Physician Attribution Technology Solutions & Benefits Data Integration Core Data Models Population Models Master Data Management • Patient Navigation • Triple Aim: • Patient Access Metrics • Healthy Population • Quality & Satisfaction • Per Capita Costs of Care Data Quality Management • Care Setting Analytics • Participants / Contributors • PCMH / PCPCH • Clinical Risk Models • Patient Engagement Real-Time Events, Alerts • Financial Risk Models • Patient Experience & Decision Support Information Lifecycle Process Models Business Models Management 6
  7. 7. Learn More…….• Register for the third webinar in the series • Bridging the Gap: Reaching Consensus on ACO Metrics • Wednesday, January 23, 2013 • 11:00am PT / 2:00pm ET• Click here to view the other webinars in the series• Click here to sign up for alerts for future webinars in the series 7

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