Accountable Care Organizations

Salient Healthcare’s ACO solution is purpose-built to help ACOs achieve shared savings and distribute them fairly. We do this by providing total visibility of critical metrics down to the TIN, NPI, beneficiary, and claim level.

Control Risk

Maintaining or appropriately increasing risk scores that accurately reflect the attributed population’s acuity of illness is a critical component in understanding appropriate spend and utilization across the population. CMS utilizes risk scores for benchmarking purposes.

  • Identify missed coding opportunities and develop strategies for follow up.
  • Identify beneficiaries with rising risk scores who may be appropriate for a (chronic care management) CCM program.
  • Measure impact of interventions/follow up efforts.
  • Determine which intervention strategy is appropriate for each TIN.

Manage Quality of Care

Completion of ACO quality metrics is an established CMS requirement in order to benefit from shared savings. Quality metric reporting is completed at the beginning of the next performance year and is a reflection of compliance of the prior year. It is important for the ACO to understand how they are performing on each individual metric to ensure a high compliance rate by the end of the year.

  • Create actionable, customized lists to share with TIN’s/Providers.
  • Identify beneficiaries by TIN that have not been seen for selected procedures.
  • Identify newly assigned beneficiaries that need to be seen for AWV.
  • Determine which intervention strategy is appropriate for each TIN.
  • Monitor progress towards quality goals.

Maintain Attribution

To ensure shared savings, an ACO must focus on keeping beneficiaries continuously assigned for those ACOs with retrospective assignment. Low churn rate enables the ACO to have lower variability in continuity of care, and therefore higher predictability of performance. Engaging the assigned population on a regular basis is critical in managing chronic conditions and ensuring quality metric compliance. Lastly, in order for the ACO to grow and thrive, they must understand why beneficiaries are losing attribution.

  • Identify and communicate opportunities for improvement and areas of success.
  • Identify which TINS/NPI’s are contributing to success and which ones need focused attention in certain areas in order to improve performance.
  • Understand relative change in performance over time.
  • Drill into a specific performance area and TIN/NPI to view more detailed data and actionable lists.
  • Develop TIN specific strategies for improvement.
  • Determine the impact of strategies that have been implemented.

Control Utilization

ACOs must appropriately utilize services necessary for their beneficiaries. Overutilization can drive up costs unnecessarily, while underutilization can have the same effect. Primary care physicians and all healthcare facilities traditionally have siloed practices but with the insight into claims and other important clinical information, the user is able to gain insights into how other services are being accessed outside of their facility perimeters.  Analyzing utilization metrics per 1000 as well as the relative change compared to prior performance is how the ACO can move towards utilization goals.

  • Create actionable, customized lists to share with TINs/providers.
  • Identify beneficiaries with high and/or increasing ER utilization.
  • Evaluate patterns of ER utilization by attributed TIN or NPI.
  • Inform strategies to reduce unnecessary ER utilization.
  • Determine which intervention strategy is appropriate for each TIN.
  • Monitor progress/impact of ER utilization.

Reduce Costs

In order to accurately identify opportunities for improvement and deploy effective strategies, it is necessary to conduct root cause analyses and identify which TINs or NPIs are underperforming across the financial KPI. Salient ACO’s Financial Opportunities dashboard to get a detailed view of the beneficiaries and cost categories that are driving spend for the ACO, Attributed TIN’s and Attributed NPI’s. The data are organized in a way that allows your users to investigate numerous pathways and to create customized, actionable lists.

  • Determine what is driving total cost Part A/Part B and Part D.
  • Evaluate TIN and NPI performance across all expenditure components and subcomponents.
  • Identify and rank spend by various facilities and specialties.
  • Evaluate LOS at facilities.
  • Isolate beneficiaries that require in depth analysis.