Analytics for Risk Contracting (ARC) Suite

The Analytics for Risk Contracting (ARC) platform helps achieve optimal value and performance for health care organizations currently in or planning to move to risk-based arrangements.

ARC pinpoints opportunities for improving care delivery and population health and the resulting net financial effect of those changes. It uses proprietary algorithms for financial modeling that enable providers to understand and explore the financial impact of various combinations of inputs, such as changes in specialty use, inpatient use, and physician incentives. Providers can see how they are performing against their care delivery and financial plans.

ARC software makes it possible for providers to confidently chart a financially viable course to accepting more risk-based payments while driving better quality, outcomes and costs.

How it works

The analytics platform delivers precise information and detailed insight from its comprehensive data inputs and analytical power.

ARC:

Aggregates data from numerous sources across the continuum of care and populations—claims, pharmaceutical, provider financials, and national, regional and network benchmarks.
Transforms, sorts, slices and analyzes data into actionable insights, such as network gaps, high-risk members or therapy effectiveness based on risk factors such as patient age and comorbidities.
Provides root causes and paths for navigating to solutions after flagging specific problems or variations within populations, service lines, clinicians or locations.

Benefits

Develop a roadmap to economic sustainability in value-based contract arrangements.
Operationalize value-based care by identifying targeted opportunities to implement population health and cost reduction initiatives to better manage a population.
Tailor initiatives to meet local and regional market nuances.
Draw on growing provider use cases to enhance learning for all.
Understand the financial impact of initiatives across an organization.
Facilitate improved care coordination and outcomes with dashboards for the entire care team—physicians, pharmacist, network managers, care coordinators, post-acute/community-based organizations, finance experts and senior leadership.
Create internal benchmarking and compare national best practices to facilitate change in physician and other provider approaches to care delivery.
Access disparate data sources, advancing data interoperability goals.
Draw on growing provider use cases to enhance learning for all.

Client Types and ARC Capabilities

Providers

Identify strategies to manage total cost of care
Aggregate complexities across all payor contracts and pinpoint areas of opportunity
Evaluate the ROI of value-based and fee-for-service care initiatives, including transfer of profitability
Increase premium revenue through membership growth, service expansion and appropriate documentation

Health Plans

Match financial data to service utilization and trends to provide actionable insights along with performance data for physician practices
Evaluate physician performance and create network tiers for targeted improvement
Create chase list for care gaps, care management teams, disease management registries or any operational action

Employer – Self Insured

Gain transparency to total cost of care
Enhance benefits design with in-depth view of employee utilization, cost and outcomes data to identify the right providers
Understand patterns of care to improve convenience and employee satisfaction scores
Expand ability to provide highest quality and most efficient sub-networks for specific treatments and services

Pharmaceutical Companies

Assess efficacy and ROI of drug therapies for specific cohorts in relation to total cost of care
Identify additional cohorts who may benefit from existing drug therapies
Facilitate developing value-based payment contracts with payor and provider partners

Stages and Benefits

Evaluate Future Contracts

Run claims data to understand historical performance and set realistic forecasts to manage costs.
Enable scenario modeling of population health management levers to arrive at effective contract terms.
Showcase intervention efficacy and quantify their contribution to managing the total cost of care for relevant cohorts.
Identify providers who deliver optimal value for members.

Manage Existing Contracts

Benchmark within your own provider population to identify best-in-class performance and help raise the effectiveness of underperformers.
Provide performance reporting to provider groups to support total cost of care management initiatives.
Understand key provider partners who are managing high-need member populations.

Identify Opportunities

Uncover areas to better manage populations.
Identify high-performing providers within your network to acquire best practices and share with the rest of your providers.
Review historical trends to build a network that meets the current and future needs of members.
Find network leakage and create programs for reducing out-of-network spend.
Develop and evaluate high-performing specialty networks to concentrate referrals.

About Us

ARC is a subsidiary of COPE Health Solutions, formed through a joint venture between COPE Health Solutions, Montefiore Health System, Adventist Health, and Dr Richard Merkin, owner of Heritage Provider Network Inc. Montefiore Health System and Adventist Health have been strategic partners with COPE Health Solutions in developing and using the cloud-native ARC tool.

ARC is available as a software as a service platform, with the option of working with COPE Health Solutions to analyze data, develop insights, understand the financial consequences and plan and execute improvement efforts.

Read the press release announcing the formation of the ARC joint venture.

Using its years of population health management experience and ARC, Montefiore’s Care Management company found opportunities to reduce single-day admissions, admissions for end stage renal disease, improve in-network referral, and reduce overall cost of specialty care.

Stephen Rosenthal
President
Care Management Company, a subsidiary of Montefiore Health System

Interested in learning more?
Download additional information or contact us for a demo.

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