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The following case study presented by Senior Business Consultant Maria Nikol and Kelly Conroy, Executive Director of Holy Cross Physician Partners ACO is a retrospective analysis of network utilization.
The Problem: Historical methods used to drive patient utilization were lacking in data validation. Patients didn’t have a way to pick facilities that had high value.
The Initial ACO Approach: As an interim method, ACOs utilized expectations of excellence in an attempt to hold out of network facilities accountable.
The Ultimate Desired Outcome: Create a high-performing preferred provider network based on quality and cost data and ensure transition coordination throughout the continuum of care.