Analytics Needed to Succeed in Alternative Payment Models

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Overview

Understanding alignment and the analytical approach behind determining an VBC's target population is a key component to the success of a program. For the DC payment model specifically, there can be a major emphasis around meeting the patient threshold to qualify for program participation, especially for entities who tread the line in terms of patient volume. DCEs receive monthly partial or full capitation payments and so accurately understanding the number of beneficiaries aligned to them is vital to their financial planning and success. In addition to pure volume at the time of the program, it's also important to understand your historical trends before making a long-term commitment.
 
Learn more about how CareJourney approaches member's questions around alignment and churn for the DC program.

Dashboard

This dashboard uses an example DCE to provide insights into alignment as well as the churn in and out to inform the DCE whether or not they have a significant churn out problem.

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Data Source & Methodology

This dashboard leverages the 100% Medicare fee-for-service claims database.

Questions?

How does CareJourney define strong vs loosely aligned?

CareJourney developed this definition in partnership with one of its members as a means to indicate whether a majority of your Primary Care Spend was attributed to your primary care provider. The measure can be used as a good proxy as to whether the patient is well aligned to their attributed provider.

All of this information is cut at the NPI level and then summed up for the purposes of this dashboard. Due to cell size loss, some data might be missing but gives a view, directionally, of whether or not the DCE has significant risk of churn out.

CareJourney can also flag which benes churned out due to death vs those that churned out and were aligned to someone else.

Please reach out to CareJourney to learn more!

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"There was a lot of collaboration in creating this packet of market analytics, looking at which metrics would make the most sense to track. CareJourney’s process of pulling this data into a multi-layered, visual user interface replaces the manual effort previously required by our analytics team."

Mallory Cary, ACO Operations Director
Prominence Health Plan, a subsidiary of Universal Health Services (UHS)

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About CareJourney

CareJourney is a leading provider of clinically relevant analytics for value-based networks supporting leading payer, provider, & life sciences organizations.

Learn more about how we help organizations achieve their goals by bringing new, high-value insights out of expansive population claims data.