The client is an independent practice association (IPA) in downstate New York, with a network extending across the five New York City boroughs and beyond. The IPA works to enable network providers to improve performance through strategic collaboration, powerful data & analytics, and enhanced provider engagement strategies. The IPA uses the COPE Health Solutions’ (CHS) Analytics for Risk Contracting (ARC) platform to identify priority improvement opportunities and to track provider engagement and performance.
The IPA had been overseeing provider performance through an internal performance tool which led to identifying the need for additional insights. These insights included the efficiency of care delivery, specialty utilization trends and a more profound understanding of high-cost services. The IPA also wanted to better understand performance of its underperforming providers collectively and to conduct peer-to-peer comparisons using various metrics.
To provide additional insight to their providers, the IPA leverages CHS’s ARC platform, identifying clear and actionable initiatives that improve and manage performance across total cost of care, quality and HCC opportunities. The IPA uses the “Cost and Use Detail” dashboard in ARC to get providers specific information on cost and utilization performance and drivers. The IPA also has found the “Cost and Use Comparison” dashboard’s ability to compare a single provider against the overall IPA’s network and the ability to drill down on top cost services in the medical and pharmacy service categories to be extremely impactful. The IPA uses the ARC “Specialty” dashboard to pull service and provider detail by specialty and clinical category, the “Inpatient” dashboard to show inpatient admissions by diagnosis-related group (DRG), and the “ED” dashboard to provide the top avoidable emergency department visits.
The IPA network team utilizes the ARC data outputs to collaborate with underperforming providers within the IPA. This collaboration has led to significant enhancements in performance. Among the targeted providers, 60% achieved success, resulting in an average 10% reduction in the medical loss ratio (MLR) from 2021 to 2022. The IPA has seamlessly integrated ARC into their fundamental workflows for their analytics solution. This integration enables them to assess their performance in relation to value-based contracts, uphold and enhance overall performance, create performance reports tailored to individual providers, and consistently furnish actionable data to IPA providers. Through the implementation of ARC, the client maintains vigilant oversight over shifts in provider performance and engagement, thereby enhancing both provider engagement and overall performance across the IPA providers.
To learn more about how we can help you utilize data analytics to improve provide engagement, contact us at info@copehealthsolutions.com or call 213-259-0245.
The COPE Health Solutions analytics platform, Analytics for Risk Contracting (ARC), has allowed us to effectively manage our VBP contracts and helps us achieve significant savings below the MLR targets.
