September 03 2019

Solution Brief: ACO Accelerator

Solution

Clarify enables ACOs to select optimal payment programs and achieve clinical and financial success:

1. ACO Program Diagnostic
– Project your performance in each CMS or commercial payment model
– Evaluate individual provider performance to hand-select program participants
-Get a sneak-peek into attributed members before fully committing to a program

2. ACO Program Success
– Monitor performance of individual providers in your network
– Increase in-network referral volume and address avoidable leakage
– Understand your members’ risk profiles and effective engagement strategies

Impact

PROJECTED PERFORMANCE INSIGHT: Accurately forecast performance in value-based payment models through an interactive financial model with built-in scenario analysis

OPTIMAL PROVIDER SELECTION: Evaluate provider total cost in your network and market to strategically select participants based on the specific payment model

REFERRAL IMPROVEMENT: Pinpoint referral gaps to improve coordination and quality of care delivery

MEMBER RISK MANAGEMENT: Understand your members’ risk factors in detail to promote targeted care management

Why Clarify

– Equipped with 100% of Medicare data and 100M commercial lives, Clarify profiles the members you will be responsible for in each program before enrolling in a program – social determinants of health data includes 400+ unique attributes at the patient level
– Aggregate patient and provider-level data models the performance impact of including certain providers in your network through scenario analysis tools
– Precise provider benchmarking is powered by case-mix adjustment incorporating clinical data, claims, purchase history and social determinants for 200M+ Americans

Case Study

At-risk PCP and ACO Convener in 11 US markets

Customer situation:
– Convener taking risk for primary care groups and ACOs in commercial value-based contracts in 11 US markets
– Considering participation in new CMS payment programs – Direct Contracting and Primary Care First
– Looking to determine strategic participation strategy

Clarify approach:
– Recommended the optimal program using proprietary comprehensive Medicare dataset on provider performance
– Analyzed each provider partner at the NPI level to determine projected performance in CMS program and financial impact in various network design scenarios
– Determined the attributed population for each provider partner and surfaced key characteristics such as patient-level clinical history and social determinants of health

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The Clarify Care Optimization Platform