Population Health Analytics Software is widely used by accountable care organizations (ACOs) that coordinate numerous hospitals, federally qualified health centers, tens of skilled nursing facilities (SNFs), hundreds of specialty care practices, primary care practices, etc. Regional ACOs report meaningful value-based financial results. In just one year, millions of dollars are saved. What strategic steps need to be taken to achieve such results?
ACOs are interested in reducing costs and pursuing new strategies to do so. For example, they implement complex care coordination programs, rapidly and methodically review and modernize payment models.
Traditional methods of care don’t support value-based payment, although it can reduce overall healthcare costs and improve the quality of patient care. Forward-thinking payers support providers who focus on the patient’s long-term health rather than those who break records for the number of procedures performed. Specific efforts to engage providers and patients are needed, as they may not have this experience.
However, stakeholders may lack reliable data and analytics to quantify gaps / ineffective variations in service delivery and identify areas for improvement.
They might look to healthtech vendors that offer data and analytics tools for healthcare companies. A Belitsoft company that provides custom medical software development for healthtech SaaS startups, creates and customizes advanced analytics solutions to improve workflow efficiency and value-based care, such as Population Health Analytics Software.
These tools enable healthcare organizations to use data-driven prioritization processes to make decisions to improve care and reduce overall costs.
Challenges the ACOs Tackle while Shifting from Volume- to Value-Based Care Models
Healthcare spending in the USA in 2024 increased by seven and a half percent from the previous year to nearly five trillion dollars.
The Centers for Medicare and Medicaid Services (CMS) invite regional accountable care organizations to test an alternative payment model. The idea is that ACOs not only take responsibility for patients’ health and actively coordinate care but also operate under payment standards that are consistent across all significant federal, state, and commercial payers.
However, accountable care organizations can struggle to coordinate and communicate across their network. Lack of access to meaningful, actionable data in near real time impacts discovery and decision-making for all stakeholders.
Without access to timely and meaningful data, ACOs struggle to prioritize their work across populations, identify population- and patient-level healthcare needs, and decide where to invest money.
Complex care coordination partners, which ACOs monitor, cannot optimize spending or quickly adjust the quality of care without access to data. Traditional static reports, which are created retroactively a few times a year, show outdated results.
Providers are unable to effectively share patient data, identify high-risk and rising-risk ones and offer them preventive interventions in time.
Moreover, unnecessary visits to doctors increase, and patients have difficulty accessing specialists and local support services.
Features of Population Health Analytics Software for Care Quality Improvement and Cost Reduction
Improved data and analytics allow healthcare organizations to track how well the organization shifts from quantity-focused to quality-focused care. Analytics take into account data on utilization and costs. Organizations can create simple self-service tools to make it easier for doctors to use the system and motivate them to use it more often. Population Health Analytics Software also allows users to:
- Integrating data from health info exchange systems, claims data from multiple payers, and data from various electronic medical records (EMRs).
- Risk stratifying for each payer separately and for all payers together based on medical claims data from different programs: Medicaid, Medicare, and commercial ones.
- Detecting patients at different risk levels of unnecessary or / and expensive medical services.
- Dividing patients who belong to an ACO’s network into risk groups to prioritize activities of care coordination and medical interventions.
- Pinpointing and deeply characterizing the unique needs and challenges of patients and communities at the greatest risk.
- Early spotting patients whose health risks increase, before they become severe.
- Applying interventions based on risk categories for patient experience and results improvement.
- Monitoring and trending changes in health risks for individual patients and different groups of people over time.
- Predicting future healthcare costs and service demands to help design better programs and resources.
- Showing changes in the performance of the medical network in reports.
Organizational Steps for Implementing a Value-Based Care Strategy
To move quickly and gradually to a model of paying for quality rather than quantity, ACOs must take certain steps.
This starts with putting more money into preventive care and primary care services. Organizations should fund providers based on how well they care for patients, not on the number of visits or tests they perform. It is also important to invest in, reward, and align care coordination processes to improve patient health outcomes and reduce the overall cost of care.
Accountable care organizations must provide all stakeholders in their network with access to actionable data so they can make more informed decisions about innovations in patient care.
ACOs can also help all members of their network better understand the data and use it effectively in their work. Analysts and clinical specialists train and support physicians in using their performance data. Teams across the network review the data, make decisions together, and share best practices with other organizations.
What Benefits Practices Get from Applying Population Health Analytics Software
Robust data analytics helps healthcare companies focus on key areas for improvement and change how care is organized and provided across their networks. This has resulted in starting a full care coordination program and lowering overall healthcare costs. The reported results include financial and operational achievements.
Financial Benefits
- ACOs get more than a dozen million dollars in positive value-based financial outcomes in just one year: lower Medicare costs than expected and favorable Medicaid fixed payments.
- The CMS confirms that the regional model with unified payment standards for all payers works.
- Responsible ACOs achieve statistically meaningful Medicare gross spending reductions at both the ACO and state stages.
- At the federal level, ACOs receive evidence that Medicare spending reduces by hundreds of dollars per patient per year in both gross and net costs.
Operational Benefits
- A meaningful increase in the number of high or very high-risk Medicare patients who visit medical facilities for primary care.
- A multifold increase in the number of patients who are actively managed in their care.
- A significant relative reduction in emergency department (ED) utilization by Medicare and Medicaid patients, that is measured per thousand patients each year.
- Improved access to relevant analytics, interest, and engagement in using the data platform among ACO network members.
How a Healthcare Software Development Company Can Support
A company like Belitsoft, which deals with custom healthcare software development, helps leading healthcare data analytics companies create strong, well-organized systems to operate their data.
For integrated data platforms created to gather, keep, handle, and interpret large amounts of data from different sources like clinic management systems, EMRs, financial systems, lab systems, and so on, the healthcare solution development organizations offer:
- Automating the workflow, such as cleansing, standardization, and normalization.
- Customizing scalable data storage systems.
- Designing dashboards, reports, and data visualizations via analytical tools.
- Complying with HIPAA via data security algorithms.
- Integrating ML and AI into analytics.
If you are searching for expertise in workflow engineering, data platforms, cloud (AWS, Azure, Google Cloud), HL7 interfaces, on-premises or hybrid environments, data analytics, and data infrastructure, Belitsoft is able to help.
The post How Population Health Analytics Helps ACOs Shift to Value-Based Payment Model first appeared on WB News.