Value Optimizer

The Health Catalyst Value Optimizer™ solution empowers healthcare leaders to optimize their strategy for value-based care (VBC) success. The application serves up insights—mined from claims data and enhanced by terminology, groupers, logic, and additional data from the Data Operating System (DOS™)—to instantly identify the most valuable opportunities for VBC performance improvement across the continuum. With comprehensive benchmarking in key domains such as post-acute care, ED utilization, inpatient care, and more, Value Optimizer is a foundational resource for organizations seeking to make population health profitable while ensuring quality care for complex patient populations.

The problem

Each year CFOs and population health executives at health systems (and other risk-bearing entities) ask themselves: What is our strategy to realize maximum value in our risk-based contracts?  Facing this question, they commonly encounter these challenges:

• They lack an approach for managing complex, risk-based populations—one that is driven by data, helps them understand their performance, and shows them which of their many options should be prioritized and pursued.
• When physicians and other stakeholders ask, “why is this the best option?”, black-box driven algorithms frustrate leaders’ attempts to present a credible rationale for action.
• Worse, the products they purchase to help them don’t produce the needed answers and the consultants they hire lack practical next steps.
• At the end of a typical year, leaders are dissatisfied with the financial results and feel there’s more potential they could be reaching. Looking ahead, they see the increasing volume of data and increasingly complex population health arrangements—and worry that the use cases they’ve faced will be more numerous and challenging in the years to come.

Our approach

Value Optimizer is an industry-leading solution to help systems master their VBC strategy and achieve profitability in population health management. Delivering data aggregation, integration, and analysis, it instantly identifies the most valuable benchmarked opportunities for improvement across the continuum—offering actionable guidance for success in risk-based contracts.

Benefits and features

With unparalleled breadth and depth, the Value Optimizer solution leaves no stone unturned in the discovery of opportunities—empowering leaders to master their VBC strategy and confidently pursue a rational course toward improved performance in risk-based contracts. Differentiators include:

• Comprehensive, quantified intelligence. Value Optimizer presents one solution to see and understand all your financial options—up to 10,000 possible opportunities across the care continuum—benchmarked and compared with dollar impact. Visualizations clearly show the most valuable opportunities for better management of VBC.
• Accuracy and context for better decisions. With continually refreshed data and benchmarking (using risk-adjusted codes, published research, or ‘digital twin’ population matching), the app serves up timely and meaningful data to guide your VBC strategy.
• Transparency, not "black box." With fully disclosed and legible groupers, metric calculations, and risk and benchmarking methodologies, the solution allows open-book analytics across 10+ domains from inpatient to post-acute, prescriptions to coding, chronic to end-of-life care, etc.
• Expert guidance. Our most successful clients work with our services team to explore opportunities within the complete clinical, operational, and financial context for a given population—accessing guidance that up-levels their strategic insight and accelerates success.

Use cases

A population health executive faces another annual planning cycle. In previous years, she’d dreaded the process, as each of the questions she submitted to data analysts required 6 months or more to answer—if the answer could even be found. Some examples:

• What’s our total cost of care (TCOC) compared to benchmarks? (She wanted to calculate gaps across the complete hierarchy of drivers and sub-drivers of cost.)
• How does the total gap for our acute-care cost area compare to the total gaps for other cost areas like post-acute, readmissions, or site of service? (She wanted to decide whether to prioritize taking action on acute-care costs or on other cost-improvement opportunities.)
• If we focus on the readmissions driving our acute-care spending, what interventions should we implement—and why? (She’d wanted to know what was truly actionable in context.)

Without reliable, timely insight on these questions, the executive was perennially frustrated, unsure how to guide the organization or effectively advocate for priorities and resources. 

This year, however, the executive and her analyst team are supported by Value Optimizer. They now have a data platform that answers critical management questions and compares key results against benchmark and against one another for easy prioritization. What’s more, they benefit from expert-led guidance that helps them weigh options for revenue, cost, and quality improvement within the context of covered populations and organizational realities.

The result? The executive is able to confidently determine priorities and craft a data-informed and defensible strategy to improve the organization’s performance in value-based contracts, to track and report on its progress, and to align executive engagement around this increasingly important part of their business.