Value-based Care Opportunity Assessment

The Value-based Care Opportunity Assessment Service is an expert-led qualitative and quantitative assessment of your organization’s infrastructure and data. The goal: to surface your best opportunities for care improvement and cost-savings—and to recommend initiatives to support short- and long-term success within specific value-based care arrangements. The service delivers data findings and an executive report with recommendations and strategic roadmap to guide sequence, pace, and scope for your population health management (PHM) journey.

The problem

Your PHM efforts are strategically important within the organization, for several reasons:

• You have dollars at risk in current contracts—or you’re considering entering new payment models. Although the amount may be modest compared to the magnitude of risk in other types of contracts, your organization needs to build competencies to succeed in these arrangements.
• You’ve made outlays for infrastructure investments. This sunk cost raises the stakes, challenging you to demonstrate early value and future promise for additional return.
• You have a lot of stakeholders—and a lot of varying interests in play. PHM initiatives typically have a broad scope, so you need to proceed thoughtfully to lay the groundwork for initial involvement and continued support for the transformational work.

These pressures make it critically important to arrive at PHM priorities using a demonstrably sound and systematic process that gives your leaders the best available information and ensures that the organization is aligned around key initiatives and goals.

Our approach

Combining qualitative and quantitative methods of assessment, Health Catalyst experts explore your PHM infrastructure and data and deliver targeted recommendations for care and financial improvement. The insight and guidance afforded by the Opportunity Assessment Service help you determine priorities that are grounded in current contractual and cultural realities, informed by a careful accounting of ROI, and aligned with the overall strategies of your organization.

Benefits and components

Clarify your current position vis a vis value-based care. Our PHM experts review your existing contractual requirements, benchmarking data, organizational performance and finances, and strategic priorities—helping to clarify near-term imperatives while establishing a baseline for improvement.

Explore and build shared understanding of your population health readiness, resources, and goals. Using a proven scoring tool, our team conducts on-site interviews with key stakeholders to better understand the infrastructure and vision for your PHM efforts. Your perspectives on governance, culture, the role of data and analytics in driving change, structures to support physician engagement and accountability, market factors, and previous efforts—all of these inform recommendations for future work and the sequence, pace, and scope of change. As needed, we provide targeted assessments to gauge readiness for care management and participation in government payer programs (ACOs, BPCI, etc.).

Maximize the strategic value of your data and analytics. Our PHM experts conduct quantitative analysis of your claims and clinical data—and in the process model for you the questions to ask and places to look for your most promising opportunities. Common areas of inquiry include:

• Clinical and cost variation exploration: Looking across your service lines, risk cohorts, contracts, and/or populations, where—and why—do we see significant variation?
• High-risk cohort identification: Which patients should we target for care management interventions?
• Utilization management: Are the services we deliver necessary, appropriate, and efficient?
• Network utilization: Are we making referrals and adapting our network to ensure that patients access lowest-cost care and stay in network?
• Site-of-care analysis: Are patients accessing services at the lowest-acuity appropriate access point?
• Care continuum analysis: Are our patients receiving appropriate transitional and post-discharge care at every stage of life?
• Patient acuity categorization: Are we accurately representing the acuity of our patient population through coding?
• Quality improvement identification: Where do we have opportunities to improve the quality of ambulatory care?

Take advantage of nation-wide experience and perspective. The PHM team has years of cumulative experience using data and analytics to help organizations achieve significant care improvement and cost savings within a value-based care models. When you work with our team, you partner with and learn from financial and clinical experts— and also benefit from our experience as a company with other health systems facing similar challenges in population health management.

Define a rational path forward on your journey to success in population health management. The Value-based Care Opportunity Assessment engagement culminates in the delivery of an executive report and stakeholder presentation that summarizes assessment findings and delivers recommendations for improvement initiatives. With available data, the service can include financial modeling regarding the potential savings or reduction in cost of care associated with specific improvement opportunities.