Analytics touted as solution for achieving value-based care

Three healthcare organizations and a consultancy have teamed to offer a platform designed to help providers better understand how they are performing against their care delivery and cost goals.

The Analytics for Risk Contracting (ARC) software, which leverages proprietary algorithms for financial modeling, is a joint venture between Adventist Health, COPE Health Solutions, Heritage Provider Network and Montefiore Health System.

“Not understanding the actual total cost of care, in detail, is a huge obstacle to moving U.S. healthcare to value-based care and risk-based payments,” says Yomi Ajao, senior vice president of population health management consultancy COPE Health, who led the development of the ARC software and is president of the joint venture.

“The tremendous promise of value-based care won’t be realized unless providers can see their way forward to accepting more reimbursements tied to cost and quality goals. ARC solves this fundamental problem,” Ajao adds.

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According to the developers, the ARC software enables providers to calculate their actual care costs and gain insights into the net financial effects of specific care improvement efforts as well as population health management and other quality initiatives.

Specifically, the analytics tool aggregates data from numerous sources across the continuum of care and populations—such as claims, pharmaceutical, provider financials, and national, regional and network benchmarks—and identifies problems or variations within populations, service lines, clinicians or locations, such as avoidable utilization.

“Within two weeks of using ARC, we identified several large opportunities for improvement,” says John Beaman, chief business officer at Adventist Health, a faith-based, nonprofit integrated healthcare system serving more than 80 communities on the West Coast and Hawaii. “We prioritized the most pressing ones and have begun the process to revise hospital contracts to generate annual savings going forward.”

“Using its years of population health management experience and ARC, Montefiore’s Care Management Company found opportunities to reduce single-day admissions, admissions for end-stage renal disease, improve in-network referral and reduce overall cost of specialty care,” says Stephen Rosenthal, president of Care Management Company, a subsidiary of Montefiore, which administers comprehensive care to nearly 500,000 Medicare and Medicaid beneficiaries as well as members of commercial health plans.

Adventist and Montefiore, strategic partners with COPE in developing and using the cloud-native ARC tool, have teamed with Heritage Provider Network to form a subsidiary of COPE to make the tool available as a software-as-a-service platform.

“ARC software is a breakthrough for advancing value-based care,” says Richard Merkin, MD, CEO of Heritage Provider Network, the country’s largest physician-founded global risk-managed organization. “It gives physicians, health systems and other providers the ability to transform their health plan contracting from volume to value. We continue to see CMS’ movement away from fee-for-service, most recently through the newly announced Direct Contracting Payment Models, and ARC can help medical groups, IPAs, ACOs and others considering these demonstrations.”

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