At-risk program for health plans is fully managed by Clarify Health

San Francisco, CA (June 13, 2023) – Clarify Health, a leading healthcare analytics and value-based payments platform company, is pleased to announce its newest program to improve specialist referrals delivered through its Clarify Advance solution. The new and improved micro-targeted incentive program rewards primary care physicians for referring patients to the highest quality, most affordable specialists in their geography. Like all Clarify Advance programs, including its site-of-service selection programs, it leverages behavioral economics to positively influence decision-making to improve care outcomes and lower cost.

Despite the overwhelming number of solutions attempting to influence patient navigation, most patients and primary care physicians still find it challenging to identify the right specialist at critical moments when care is needed. Clarify’s specialist referral program helps health plans empower physicians with reliable access to data on specialists’ cost, quality, access, and patient experience to inform referrals and rewards them for making higher-value care decisions.

Specifically, the new specialist referral program offers participating physicians:

    • Personalized recommendations for preferred specialists based on geography, past use, and affiliation with a health system.
    • Breakdowns of each specialist’s clinical area of expertise.
    • An affordability score that assesses each specialist’s ability to best manage utilization with their overall cost.
    • A quality score detailing metrics specific to the specialty.
    • Data on how long patients typically need to wait to visit each specialist.
    • Transparency and incentives linked to how much they are saving patients.

“We know prices for identical services vary tremendously among providers. Providers have no insight into the rates of facilities and the numerous specialists in their network, or which ones provide the best outcomes at the lowest cost,” said Ezekiel Emanuel, MD, vice provost for Global Initiatives at the University of Pennsylvania, co-director of Healthcare Transformation Institute, and strategic advisor to Clarify Health. “With behavioral science and micro-targeted incentives, we have a proven approach to accelerate the adoption of high-value clinical behavior, which in turn, can lower healthcare costs and improve outcomes.”

Through Clarify Advance, physicians are positively incentivized with personalized and timely rewards, driving lasting behavior change and significantly reducing the total cost of care. Clarify manages the entire program, from physician recruitment all the way to payment. Without cumbersome contract management, performance monitoring, and reporting, health plans can save up to $6 for every dollar of incentive paid, which results in a 6:1 return on investment. The program has been proven to increase participating providers’ use of higher-value options by 15%.

“Payment models in healthcare are broken,” said Clarify Health Founder and CEO Jean Drouin, MD. “By applying big data and AI to healthcare reimbursement, we are working toward a world centered around high-value clinical behaviors where utilization management and prior authorization are things of the past. Applying innovative approaches backed by behavioral economics, software analytics, and coaching models developed in partnership with physicians and researchers, Clarify Advance unlocks the secret to driving behavior change inside clinical practices.”

Because participation presents no downside risk to their practices, physicians have reported high levels of engagement and overall satisfaction, with 100% renewing their participation after the first year in the program.

“The program has helped us save our patients thousands of dollars in out-of-pocket expenses,” said Atlanta-area orthopedist Filippo Chillemi, MD, participating in the site-of-service selection program. “The fact that Clarify runs the program seamlessly means I am not tied up in administrative work, have easy access to a personalized list of options, and can spend more time with my patients. It’s a win-win for everyone.”

New Podcast: Healthcare Unbound

To learn more about game-changing physician incentive programs, please join the launch of our new podcast series, Healthcare Unbound, with Clarify Health Founder and CEO Jean Drouin, MD. Our first guest is Amol S. Navathe, MD, PhD, associate professor of Health Policy and Medicine at the University of Pennsylvania, a staff physician at the Philadelphia VA Medical Center, and a strategic advisor to Clarify Health. Dr. Navathe is a leading scholar on the impact of value-based care and payment models, and financial and non-financial incentive design using behavioral economics.

Interested in Clarify Advance for your organization?

There is one physician incentive program that rises above all others. Join your peers in adopting Clarify Advance, a fully managed, at-risk physician incentive program proven to deliver high physician engagement and fast medical cost reduction. Please contact us directly here.

About Clarify

Clarify Health is an enterprise analytics and value-based payments platform company that empowers payers, providers, and life sciences companies to deliver better care, therapies, and outcomes with actionable patient journey insights. Clarify’s cloud-based business applications are built on the Clarify Atlas Platform, which maps 300M+ patient journeys to deliver 18B+ AI-powered predictions and surface insights with speed and precision. Clarify’s products illuminate actionable opportunities to drive growth, optimize networks, improve care delivery, manage population health, maximize value-based care performance, and bring therapies to market. With Clarify, healthcare organizations can leapfrog from point-solution and manual analytics to self-service, rapid generation of enterprise insights that light the path to better care and outcomes.

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Rose A. Lewis
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