Minimizing Risk to Achieve Value-Based Care Success for ACOs

As the healthcare industry continues to shift towards value-based care (VBC), Accountable Care Organizations (ACOs) face the critical challenge of balancing high-quality care with favorable financial outcomes while managing increasing financial risk. This task requires a deep understanding of patient populations and overall performance, which can be significantly enhanced through advanced data analytics. This blog explores how ACOs can leverage data analytics to minimize risk and achieve success in value-based care.



Challenges Faced by ACOs

ACOs often operate with limited resources dedicated to data analysis. Many lack a chief actuary and instead rely on a Chief Financial Officer (CFO) to manage financial risks and performance assessments. Additionally, ACOs may not have extensive experience in risk adjustment or the effective use of healthcare groupers. The analytical tools at their disposal are often limited to the capabilities of their electronic medical record (EMR) systems or basic business intelligence (BI) software like Microsoft Excel, Power BI, or Tableau.

Compounding these challenges, ACOs typically lack a substantial financial reserve to cover risks such as claims liability incurred but not reported (IBNR) and other unforeseen expenses. This makes it crucial for ACOs to adopt advanced data analytics solutions that can provide timely, normalized, and contextualized insights.

Achieving VBC with Advanced Analytics

Data analytics is essential for ACOs to successfully navigate the path to value-based care. By harnessing data and insights, ACOs can:

- Rapidly aggregate and normalize claims and clinical data.

- Gain a comprehensive view of their business.

- Enhance patient population evaluations.

- Ensure the delivery of appropriate care.

- Pinpoint areas for risk mitigation.

- Make necessary adjustments to care delivery models efficiently.

How HC Insight's Value-Based Care Analytics Can Help

HC Insight offers a powerful Value-Based Care Platform designed specifically for ACOs. This platform provides:

- Timely, Normalized Insights: Aggregates and contextualizes data to deliver actionable insights.

- Scalability: Tailored to scale alongside the level of risk assumed by each ACO, allowing for effective contract pricing, identifying gaps in patient care, and enhancing patient well-being.

- Comprehensive Support: Includes analytic intellectual property (IP) and methodologies widely adopted in the healthcare marketplace, such as the Milliman Advanced Risk Adjuster (MARA), Chronic Condition Hierarchical Groups, Benchmarks, and Health Waste Calculator.

Benefits of HC Insight's VBC Platform

The HC Insight Value-Based Care Platform enables ACOs to:

- Determine Contract Pricing Effectively: Use data-driven insights to negotiate better contracts.

- Identify Gaps in Care: Ensure patients receive necessary and timely care.

- Enhance Patient Well-being: Improve overall health outcomes through targeted interventions.

- Qualify for Quality Incentives: Meet and exceed quality benchmarks to earn financial rewards.

- Achieve Desired Financial Outcomes: Optimize financial performance by managing risks and costs effectively.

Implementation and Customization

HC Insight ensures seamless implementation and customization of its platform to meet the specific needs of each ACO. This includes comprehensive training for ACO teams to proficiently use the system, ensuring they can leverage the full potential of the analytics provided.

For users of Epic, the core analytic methodologies powering the HC Insight VBC platform are integrated with the Value-Based Performance Module (VBPM) of Healthy Planet. This integration allows Epic customers to understand the drivers of financial and health risk and take actionable steps to achieve their population health goals.

Conclusion

Minimizing risk through advanced data analytics is key to achieving success in value-based care for ACOs. By leveraging comprehensive and contextualized insights, ACOs can enhance patient care, manage financial risks, and optimize their overall performance. HC Insight's Value-Based Care Platform offers the tools and support necessary for ACOs to navigate the complexities of value-based care and succeed in their missions.

For more information about how HC Insight can help your organization on its journey to risk management and value-based care success, contact an HC Insight analytics expert today.