Quality
Oct 25, 2023
Watch this video of Clarify Health’s President, Todd Gottula, to hear him discuss how to accelerate adoption of value-based care at the AWS booth. He described five pillars of success:
- Precise provider performance benchmarking
- Digitization of value-based contracts
- Incentives and analytics to help clinicians make better care decisions
- Integration of clinical and financial performance analytics into provider workflows
- New economic models, such as giving providers access to capital before the settlement end period
Exclusively built on Amazon Web Services (AWS), Clarify’s healthcare and life sciences cloud software applications leverage the industry’s most mature and reliable platform for enterprise-wide insights and value-based contracting.
Video Transcript:
Todd Gottula:
Thank you everybody. Thank you. Yes. So I’m Todd Gottula, President and Co-Founder of Clarify Health Solutions, here to share a little bit about what Clarify does, our longstanding partnership with AWS, and ultimately, how we and our partner organizations are seeking to improve healthcare outcomes and drive individuals towards living better lives. So raise your hand if you have heard an organization stand on a stage like this and talk about the fact that they are here to power better care. Never heard that one before? So yes, we at Clarify exist to enable individuals to live better lives. Now we’re not frontline care providers, so we’re not in the business of actually delivering care or as a plan or a life sciences company provisioning care or developing therapies. Instead, we power those organizations that are out there doing great work, helping individuals live the lives that they deserve, and receive the type of care and the quality outcomes that they ultimately are seeking.
Todd Gottula:
Now, what’s different about Clarify? At the end of the day, it comes down to five specific pillars. The first is that we have created the most accurate performance assessment platform that has existed in the healthcare industry. And I say that with extreme confidence, and I’ll explain why I am so confident that it is the ultimate tool for being able to understand where there’s value creation and destruction in a healthcare system. The second is that we provide a platform for the digitization of value-based care contracts or any form of fee-for-value. The third is that we put those insights into the hands of clinicians with micro incentives to help them understand exactly what the benefit is for them to take an incremental or different decision as a patient is going through a care journey. Fourth, we put those insights specifically into the EMR or the other workflows that exist in healthcare so that there’s no disruption to how care is being provisioned or delivered today. And then fifth, which is what we’re going to do next, is we’re going to enable a different economic model that allows for capital to flow much more efficiently. So for example, when an organization’s in a value-based care contract or a value-based arrangement, that they’re able to get access to that capital in advance of the end settlement period, thereby enabling a much more rapid transition from fee-for-service to fee-for-value. Now, we completely acknowledge that the market today is primarily fee-for-service. And so the combination of capabilities we have today allows us to serve those organizations where they are today, while then empowering or enabling them in the journey towards a much more efficient and effective healthcare system, which is one that’s governed by fee-for-value.
Todd Gottula:
All right. So what does that actually mean in practice? Well, what that means is that we have taken all of the country’s available healthcare data, primarily claims data now augmented by clinical data, and organized it into a series of patient journeys for every single American. Now, why is that important? Well, the way to improve healthcare outcomes is actually governed by a set of very specific decisions, where if those decisions can be made in a more informed way, individuals will receive much better outcome. So take the example of a referral from a primary care physician to a specialist. If that referral can be done in a much more personalized way to a specialist that has positive experiences with treating the patient, like the one that’s being referred, then all subsequent care is going to be much better, much more efficient, and ultimately lead that patient to a better outcome.
Todd Gottula:
So, we fundamentally believe that you don’t have to do clinical decision support at every node through the patient journey, but if you just nudge the patient, and therefore the care provider, along that journey, that those individuals will end up in much better outcomes. And so you see on this slide, examples of where they’re the types of decisions that we fuel that ultimately can root out 60, 70% of what currently is inefficient care and where individuals are not necessarily getting the optimal outcomes from the care providers that they’re engaging with.
Todd Gottula:
So, what does that mean in practical sense? What is it that Clarify has built? Well, so we like to present this in a layer cake. It starts with the data. So as I mentioned, we have acquired information or signal on every single individual. So everyone in this room, everyone in the country, we have at least some indication of what their historical encounters have been with the American healthcare system, a subset of which we have all of their information available. Now this is highly de-identified, it’s focused on the healthcare they’ve received, not who they are. But that base data layer allows us then to, as I mentioned, put all of that data into patient journeys.
Todd Gottula:
And then once you have all of the patient journeys, which it totals around 15 billion different patient journeys, when you think about a single individual being attributed to their primary care physician, all the specialists that they’ve seen, all the facilities with whom they’ve encountered, you now have an incredible ability to compare any specific patient journey or set of journeys to all those others. And you can create, which we have done, the most case mix-adjusted high-fidelity assessment of where there’s value creation or destruction in the healthcare system. And then once you know where opportunity exists, you can put that opportunity in the context of the workflows, through business applications, to ultimately drive value.
Todd Gottula:
So, what’s the type of value that we’re driving in healthcare systems? First example, which I’ll go through in more detail in a moment, is a large health system in New Jersey. We’re just in our initial deployment. Within six months, we identified over $285 million in addressable opportunity that is now being rolled out to the clinicians in the workflow. And they are over a quarter of way to realizing that ultimate end goal. And that’s just the first step, because it’s a continuous learning system, that once we rebase onto the new performance level, we then seek to find the next set of opportunities to continue to drive value, to continue to provide better outcomes, and ultimately allow individuals or empower individuals to live better lives.
Todd Gottula:
Additional examples in a high-risk population where the PMPY is typically around 18-19,000, we identified over $5,000 of savings opportunities while also driving better outcomes. So maintaining quality, reducing utilization, rooting out unwarranted clinical interventions, and ultimately allowing and empowering individuals to live their best possible lives. And how do we do that? We do that incredibly efficiently. So that final example is a national carrier who’s able to build efficient networks eight times faster, empowering them to get into market in a way in which they’re able to then attract new business, ensure that those members are getting the quality care that they deserve, but reducing dramatically the time it takes for them to get on market, dramatically increasing their overall ROI.
Todd Gottula:
So I want to conclude by talking about that specific example, that was the first one on the previous slide, which is our partnership with Blue Cross Blue Shield of New Jersey, Horizon. Organization’s been a partner of ours for several years. You can see some of the sample insights up on the screen here on the right-hand side, which are actually screenshots of our capabilities and our software. These insights are identified on their member population using all of the historical data that we have sourced to create these patient journey-specific benchmarks. We then aggregate those on a physician-by-physician basis, and then deliver the improvement opportunities into the specific physician workflows as they’re going about understanding their relationship overall with Horizon.
Todd Gottula:
The driver here is to participate in the OMNIA narrow network program. So it’s a network within a network that has significant benefits to those individual physicians that are performing or being a part of that network. And what we do is, again, give them how they’re performing against certain specific targets. And then we give them what they need to do differently, or how they could improve, in order for them to meet those performance targets and then ultimately receive the referral volume that’s part of that narrow network product.
Todd Gottula:
Now this is just a small sleeve of what we do. We have a series of capabilities across the payer provider and life sciences landscape, all leveraging the incredible technology that we’ve built in partnership with AWS and the different AWS componentry, that allows us to both store this data, rapidly process it, normalize it, and train the predictive models using all of the AWS data science suite in order for us to be able to bring these incredible products onto market.
Todd Gottula:
Thank you.
Want to refer back to these steps later or share them with your colleagues? Download our 5 Steps to Success in Value-Based Care Infographic.
