July 02 2019 Manisha Shetty Gulati

Addressing Today’s Healthcare Challenges Using Precision Analytics

Last month Clarify Health released several new predictive analytics solutions to address the critical challenges payers and providers face as they work to optimize patient care, manage risk, and improve outcomes.

Health plans today lack the necessary insights on performance to build high-performing provider networks. Currently, they rely on a small sliver of market data and benchmarking methodologies that only compare to “average” performance, resulting in an inadequate picture of provider performance on the quality and efficiency metrics that really matter. Clarify’s Network Performance Optimization solution helps payers identify the optimal geographies and the top-performing providers to design and manage high-value networks, and provides insights into provider performance across cost, quality, and utilization.

Risk scores are the basis of care management programs, but their effectiveness is inadequate because they often have limited actionability. Today’s risk ratings rely mainly on clinical factors and forget the critical social and behavioral determinants of health (SBDoH) that can improve risk assessments and highlight intervention opportunities. Clarify’s new Member Risk Management solution delivers powerful, transparent predictions based on clinical, social, behavioral, and utilization factors that impact members individually. This allows you to address the causes of this risk and personalize the care for each patient who needs it. You can also engage care teams and increase care manager satisfaction by empowering them with the insights they need to be effective, including patient-specific SBDoH and other key risk drivers.

Other tools on the market struggle to map referral flows in a timely or granular enough manner to generate specific insights by individual practice, physician or procedure. Clarify’s Network Referral Intelligence solution drives top-line revenue and continuity of care through enhanced visibility into referral patterns across markets at a granular level. Our data set unlocks enhanced visibility into health system volume flows, while our analytics platform allows for forensic interrogation through drill-downs all the way to procedure and site level. You can identify sources of volume and downstream utilization to assess how patients flow through care, and determine which physician groups to partner with for growth. We’ve seen in-network referral improvements of just 5-10% result in over $100M in incremental net revenue for a $1B health system.

Other new payer and provider-centered solutions include:

  • Inpatient Care Improvement: Precisely benchmark hospital utilization and quality performance and pinpoint interventions to improve your bottom line. Clarify addresses the actionability challenge by leveraging a powerful machine learning engine to deliver precisely case-mix-adjusted assessments of utilization and quality metrics that impact internal hospital costs and reimbursements. We give hospital leaders a platform to more thoughtfully engage physicians on addressable clinical variation, with granular utilization and quality performance data to accelerate behavior change.
  • BPCI Advanced: Improve clinical and financial performance in bundles and maximizes episode performance and bonuses. As a CMS Qualified Entity, Clarify leverages vast data and machine learning to more precisely inform the episode selection process, delivering benchmarks on current baselines and predicting future performance. Case-mix adjustment algorithms illuminate specific opportunities for improvement at the individual patient level.
  • Total Cost of Care Insights: Provide a 360-degree view of cost and quality, identifying revenue growth, quality improvement and cost-reduction opportunities at the health system level. Clarify quickly delivers a detailed four-part (referral flows, ambulatory, acute, post-acute) diagnostic by processing its rich dataset through a built-in grouper that dramatically simplifies the task of selecting and comparing sites, procedures and individual physicians. Customers receive ongoing, real-time access to insights, dashboards and reports automatically as data is refreshed.

Why Clarify:

Clarify provides the predictive solutions and actionable insights to address the most pressing payer and provider needs and drive bottom-line impact. Clarify’s solutions are fueled by a growing patient-level data set encompassing over 200 million lives and incorporating clinical, claim, prescription, lab and socio-behavioral determinants of health data. Powered by a technology stack similar to those used by banks and internet retailers, Clarify has built a foundational analytics platform enabling faster and more targeted deployment of machine learning and artificial intelligence (AI) to deliver predictive and actionable insights on patient journeys.

This post was originally shared on LinkedIn. To learn more about Clarify’s new solutions offerings, click here to contact our Sales team.

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