ACOs must appropriately utilize services necessary for their beneficiaries. Over utilization can drive up costs unnecessarily, while under utilization 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.