May 22 2018 BY: Sarah Chen, MD

San Francisco Bay Area John Muir Health Partners with Clarify Health to Optimize Performance in Value-Based Care

Today we announced our continued partnership with Bay Area health system, John Muir Health (JMH). John Muir Health is one of the largest CMS Total Joint Replacement (TJR) providers, performing 750 Medicare TJR procedures each year. In 2016, the health system was mandated to participate in CMS’ then-mandatory Comprehensive Care for Joint Replacement (CJR) bundled payment model. Today, John Muir is ranked #1 in California and #4 in the US for CJR per patient bonus, proving that quality goes hand-in-hand with delivering more affordable care.

As you may know, CJR holds participants accountable for the quality and cost of an entire episode of care, starting from the patient’s TJR admission and ending 90 days post-discharge. Each year during the program, CJR hospitals are given set episode target prices and quality goals. At the end of a model performance year, actual spending for the episode is compared to the target price and depending on the participant’s quality and episode spending performance, the hospital may receive a bonus or penalty from CMS.

When JMH first embarked in CJR, a team of analysts spent countless hours manually manipulating their raw claims data in an attempt to understand their CJR performance. Quickly realizing their traditional labor-intensive methods of analysis would not be sufficient to monitor performance in the program, JMH sought to source a solution to generate actionable insights to engage physicians and deliver both improved care and savings. The JMH management team looked for a partner to provide answers to three critical questions:

  1. Where do we stand in the CJR program?
  2. Can we generate actionable insights that will engage our physicians?
  3. What actions should we take to optimize care, deliver a great patient experience, and ensure we realize a bonus?

Clarify Care Prism was selected based on the intuitive nature of the platform, its precise case-mix adjustment, its AI-generated insights, and the support provided by our clinical transformation and implementation team. Within a few weeks, JMH had a detailed view of its operational and financial performance at a facility, individual physician, and affiliated partner (e.g., skilled nursing facility) level. The team was able to identify relevant variation and generated specific improvement insights while still cutting the time required to process data and generate reports by over 50%.

“Clarify’s solution provides the critical analytical foundation for our bundled payment programs. It delivers the actionable insights we need to help our physicians and care team deliver high quality and more affordable care for our patients,” said Patty Haggen, Executive Director of Hospital Operations and Orthopedics, John Muir Health.

The health system scored an excellent rating on quality while also capturing $1,900 per episode in bonus in the first year of the CJR program, the best performance in the Pacific region and the 4th highest in the US.

“Ultimately, we look for solutions that are going to benefit our patients and the communities we serve and Clarify was able to partner with us to deliver on that goal. The lessons learned and best practices are ones that we want to continue to expand on and implement across our health system,” Haggen added.

Value-based payment models are redefining our industry and the shift to value-based care requires a greater focus on improving quality and reducing costs in parallel. The feedback received from John Muir Health is that it’s incredibly frustrating to manage value-based programs in the dark, without the evidence to inform and support decisions. Clarify provides customers with the critical analytical foundation for their bundled payments program. It delivers the actionable insights needed to succeed in the CJR program – understanding of performance, real-time analytics that engage physicians and help prioritize decisions and focus.

John Muir Health is a perfect example of a health system that has seized the opportunity in CJR and realized significant improvement. If you have questions about how we can support the delivery of better and more affordable healthcare contact us at [email protected].

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