Expanded access to claims, EMR, ADT (Admission, Discharge and Transfer information), health related social need and other health care data sources through maturing health information exchanges, integration solutions and other avenues is creating new opportunities for both providers and payers.

At the same time the volume of data available and diversity of data sources can present new challenges and barriers and can easily overwhelm providers.

Providers, particularly physicians, medical groups and FQHCs need to consider:

• What do I need to look at to run my practice?
• How do I see where I stand in performance against guidelines or targets?
• How is my staff performing?
• Is my practice growing and remaining financially stable?

Analytics tools with configurable dashboards are available to assist busy physicians and their staff to monitor and improve performance without having to sift through and normalize reams of data from various sources.

The key to success is to determine what metrics are most important in assessing and accelerating improvement opportunities.

Quality and Cost Efficiency Metric Tracking Through Dashboards

Practices involved in Value-Based Contracts have quality, cost efficiency and often other key performance indicators (KPIs) which are used in determining bonuses available for achieving or exceeding benchmarks. The issue has been that the practices did not always have the ability to see in a timely manner where they stand in achieving their bonuses, or what opportunities existed for changing some aspects of their practice in order to meet their KPIs.

Practices often have to wait until all claims were reconciled and measures by a payer to review the results and distribute a report that contained data that could be several months or even a year old. This creates missed opportunities to improve on performance and achieve that coveted bonus.

Today’s top data analytics platforms have data integration capabilities and configurable dashboards that allow physicians and others on the care team to see and act on KPI information faster.

What are the parameters that are commonly priorities for functional dashboards to power success in VBC agreements?

1. Attributed Membership: View the current membership in your practice, group or organization that is counted as part of the performance contract
2. Quality and Total Cost of Care Metrics: Know the following:
   1. Which quality measures are part of the value-based agreement and how they are defined (numerator/denominator and criteria for inclusion or exclusion from the measure)
   2. Where you currently stand on achieving quality and total cost of care targets
   3. Who still needs to be contacted to have care gaps closed
   4. Where are there opportunities to avoid high-cost services and utilizatio
3. Utilization and Cost of Specialists and Other Providers – Clinical Continuity:
   1. Determine which specialties are used most often and which specialists within those specialties are the most cost effective and have the better quality and total cost of care score impacts.
   2. Understand where utilization is going by specialty, specialist and other provider and service types in order to optimize clinical continuity within your own network and care model versus “out of network” utilization that can disrupt care and member engagement
4. Risk Adjustment: Ascertain how your risk scores correlate with your perception of how sick your patient population is.
   1. If you feel you have a less sick population than you expect, you can go back and review some patient medical records to confirm appropriate documentation of current medical problems and procedures, as well as medications and social issues.
5. Bonus earned: Based on the scores above, you may be able to determine bonus eligibility (or deficits) based on the scores, or that information is included in the dashboard.

If you would like more information on analytics and dashboards, please reach out to COPE Health Solutions at info@copehealthsolutions.com or call 213-259-0245 for a demo of our data analytics engine and opportunities to improve your performance.