We support customers across the full lifecycle of bundle and episode performance: design, contracting, care optimization and reconciliation. Clarify’s BPCI Strategic Decisions analytics rapidly reveal which episodes a provider should contract into and why. For commercial bundles, we leverage a database of over 60 million commercial lives to provide greater transparency in design and contracting. To optimize care, we focus on three levers: clinical performance, predictive matching of patients to personalized care maps, and real-time guidance. Our value-based Program Administration solutions forecast performance while patients are in flight and automatically calculate incentive and gainshare payments.
BPCI AND COMMERCIAL BUNDLE STRATEGIC DECISIONS
Selecting which episodes to pursue requires precision. Performance in the BPCI program is based on improvement against a shifting baseline and target price. Meanwhile, agreeing on the right price in commercial arrangements has been somewhat of a dark art. Knowing where you stand is essential in selection, design and contracting.
Clarify goes beyond the traditional approach of assessing opportunity based largely on episode volume, unadjusted benchmarking and linear calculation of upside potential. Our customers receive the full power of our deliberate investment in building a database covering over 42 million CMS and 60 million commercial beneficiaries, and developing the data processing and machine learning algorithms to interrogate the data with millisecond response times.
This degree of automation allows us to:
1. Directly source in your data from CMS into your own secure cloud environment
2. Augment your data with EMR, demographic, determinant of health, social and other data sets
3. Load in the algorithms and predictive models to clean, process, and analyze the data
4. Return a precise diagnostic for which episodes to pursue
5. Provide 24/7/365 access to your data environment
Why does this matter?
Case-mix adjustment. Does your current episode analytics provider adjust for case mix? Our research clearly shows that case mix can vary significantly.
Data access. Do you have direct access to your data? Or is your data held hostage behind a shield of ‘we send you regular reports and call us if you want a download?
Forecasting. Can you easily change assumptions and run scenarios to act in anticipation of the future?
We firmly believe that well-managed episodes result in win-win-win situations. Improving quality and satisfaction reduces waste, lowers costs and improves outcomes. Our experience generating over $1 billion in savings at over 125 health systems has taught us to focus on three levers: clinical performance, predictive matching of patients to personalized care maps, and real-time guidance.
Clarify’s Care Prism machine learning analytics rapidly surface specific quality and cost opportunities at individual physician and patient level. Inspired by the powerful techniques used by banks to value derivatives and risk, Care Prism frees analysts from pivot tables. Calculations that typically take weeks are now returned in seconds. This, in turn, enables the same granularity of segmentation and personalization more typically associated with the likes of Amazon than healthcare organizations. Physicians can now see exactly which of their patients need additional attention or different interventions. For example, a total joint replacement surgeon can now see exactly how his diabetic patients do vs. those with hypertension, or how her elderly patients perform vs. those under 65.
Learning from retrospective performance typically allows organizations to capture 25-35% of the available quality and cost improvement. We believe it is essential to go the next step and prescribe a personalized start-to-finish care map to each patient. Providing such a map lowers anxiety and makes it easier for patients and family members to actively participate in their care. Critically, it also creates accountability and narrows delivery variation on the part of the care team.
With personalized care maps in place, why not then offer patients the option to be guided turn-by-turn, in much the same way as automobile navigation apps? By turning on GPS for care journeys, it becomes possible to spot problems before they occur, such as unnecessary readmissions when patients end up in the emergency room.
Patients and their caregivers can become full partners in their care journeys when Clarify’s Care Pilot patient engagement app is prescribed to them. Care Pilot contains the patient’s start-to-finish care journey, with step-by-step directions and the ability to communicate with and send important information directly to the care team. Clarify Care Connect then empowers care navigators to become fully fledged care traffic controllers, with the ability to guide panels of in-flight patients through their journeys.
VALUE-BASED PROGRAM ADMINISTRATION
Sustaining improvements requires identifying and rewarding partners across care journeys. Many providers and payers today still rely on manual methods to calculate and award bonuses, and on gut instinct to select preferred partners such as skilled nursing facilities.
Our value-based program administration solution automates much of this work, reducing processing times while offering an objective third party approach that eliminates the need for dueling reconciliation between parties. In commercial bundles, we are building the software capability to manage prospective arrangements. Health systems and physician groups will, therefore, be able to agree a fixed price and receive payment up-front, while having the confidence that downstream billing and reconciliation arrangements with partners will be handled more smoothly than today’s manual approaches.
BETTER BUNDLE CHOICES
Far more rapid and precise analytics enables better bundle choices.
STRATEGIC AND MARKET INTELLIGENCE
Instantly leverage Clarify’s 100m+ lives database to pinpoint your performance, strengths, and weaknesses. Use this knowledge to your power better strategic decisions and negotiations.
HIGHER QUALITY AND BETTER OUTCOMES
Care Prism delivers precise information on which types of patients need greater focus along a host of quality metrics, including readmissions and mortality. Automatically forecast the impact of quality on your finances.
REAL CHANGE AND LEARNING
Actionable insights lead to collaborative conversations between care teams to standardize best practices and make timely updates to practice patterns.
By closely managing performance on a granular level and in real-time, our customers deliver more effective and efficient care, thereby ending up on the right side of the risk equation.