Success Stories

Risk Adjusted Insights for Medicare, Medicare Advantage and ACA Populations

The Context:

A top-ten health system in the US had trouble managing over 25 value-based contracts, leading to inaccuracies in risk adjustment, reducing confidence and abilities in making good strategic decisions, and delaying improvements to patient care. It was hard for this client to make operational decisions for risk adjustment workflows without the right data and data insights, and not knowing if the data presented was accurate or meaningful.

The Solution / Outcome:

Project outcome is the client saved over $110,000,000 in their annual benchmark spend, achieved 12% improvement in the wellness visit rate, and attained an 8% improvement in refresh rate year over year by leveraging the new and industry leading data dashboard that integrates over 360,000 Medicare Advantage (MA) and Affordable Care Act (ACA) commercial populations and that provides real-time accurate and actionable risk adjustment metrics.

The risk adjustment data model was tailored to their needs and more thoroughly provided insights for performance across contracts, service areas, departments, and provider levels. With a newly formulated solution strategy & design, program management, EMR workflow optimization, the client had a clear path forward to success by having a data plan tied to their objectives.

Population Health Platform Implementation with Quality Analytics

The Context:

A client using a third-party Population Health management platform struggled with clinical integration and close quality gaps in care. The physician quality reporting system and quality payment program data submission to Center of Medicare & Medicaid Services (CMS) was not reliable or accurate leading to various complications and costs. Better quality workflows & insights, accurate information, and a better strategy was needed to improve efficiencies and patient care.

The Solution /Outcome:

Client saved $22,000,000 in under 2 performance years and achieved a 91% quality composite score by having a net new analytics platform across multiple modules that monitors over 20,000 Medicare Fee-for-service members.

Population Health Management solutions for quality improvement, care management, and utilization analytics were strategically combined with more than thirty quality measures being developed and delivered to the client, which also achieved quality measures data submitted to CMS on time.

Data Operations, Data Resources, Data Advisory, & Data Implementation Training

The Context:

A leading healthcare IT Data platform vendor was having issues with slow implementations and needed guidance with data aggregation and analytics solutions on a cutting-edge platform.

The Impact:

Client increased data implementations speed by 42%, accelerating data implementations to 10 in a matter of weeks. EMR data was extracted, accurate data pipelines were built, and customized-meaningful and simplified reports & dashboards were created that left the greatest impact to Fee-for-Service and Value-Based care use cases.

By providing knowledgeable and high-quality senior data engineers, analysts, and EMR consultants, the population health management implementations were impactful and long lasting for multiple health systems, accountable care organizations, and clinical integrated networks.

Actionable Cost & Utilization Insights for Medicare, Medicare Advantage and Commercial contracts

The Context:

A health system in North Carolina was struggling to manage costs and utilizations for their 150,000-patient population and across their ten value-based care contracts. Although they were working with multiple vendors, each had an incomplete and conflicting strategy and advice that didn’t equate to an overall successful strategy.

The Solution / Outcome:

A custom dashboard was implemented that integrates all 6 value-based care contracts and monitors over 80,000 Medicare Advantage (MA) and Self-employed populations. The client was now able to more efficiently and better manage both costs and utilizations, have the right information delivered in real time, and see claims-based cost and utilization insights at both the contract and provider levels. The new ability to easily compare costs to previous years and compare performance to payer and provider attributed populations, added significant value.

Data was brought into an EMR-adjacent data warehouse, and the Cost and Utilization Analytics data model were redesigned with new abilities to show claims-based insights up to 3 years. The solution strategy, program management, and solution design services successfully guided the client going forward. The client stated that Percept Health’s dashboard was more accurate than any of the other’s they’ve seen or used.