CJR Year One Down, Outcomes and Margins Up

We're helping our partners optimize care in CJR.

CJR: Bay Area Customer Rises to #1 in California, #4 in US

John Muir Health system deploys Clarify Care Prism analytics to optimize care and CJR performance.

“Clarify’s solution provides the critical analytical foundation for our bundled payments program. It delivers the actionable insights we need to succeed.”
– Patty Haggen, Executive Director Operations and Orthopedic Service Line

When John Muir Health, located in the San Francisco Bay Area, was selected for mandatory participation in CMS’ Comprehensive Care for Joint Replacement (CJR) bundled payment model in 2016, the health system rose to the challenge.
Teams of analysts spent months and countless hours performing manual calculations using Excel and pivot tables to monitor their CJR performance. Recognizing that this was unsustainable and with mounting pressure to have solid analytics in place before the end of their first program year, John Muir Health management and orthopedic service line leaders looked externally.

Aiming for success in CJR, the leadership team faced three critical questions:

  • Where do we stand in the CJR program?
  • Can we generate actionable insights that will engage our physicians?
  • What actions should we take to optimize care, deliver a great patient experience, and ensure we realize a bonus?
185% improvement in total bonus during Clarify’s tenure

The shift to value-based care requires a greater focus on improving quality and reducing costs in parallel, just as occurred in the automotive and computer industries. Transparency in this situation is extremely powerful – 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’s solution provides the health system with the critical analytical foundation for their bundled payments program. It delivers the actionable insights needed to succeed in the CJR program.

The analytics, insights, and support provided by Clarify enable the health system to:

  • Understand their performance
  • Effectively engage physicians
  • Make decisions more rapidly
  • Prioritize where to focus

#1 in the Pacific region and Top 5 nationally in CJR.

The health system scored an excellent rating on quality, confirming that providing exceptional quality can go hand-in-hand with delivering more affordable care. They also captured $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. This is particularly notable as they are one of the highest-volume total joint replacement (TJR) providers in the Pacific region, which is one of the most resource efficient regions in the US.

In August 2017, CMS moved to scale back the existing CJR model, lifting the mandate from 33 of the 67 geographic areas chosen for the program, and giving John Muir Health the option to drop out of the program. However, due to their past success and clear opportunity for success ahead, they decided to stay in the program as a voluntary participant.

Their success in optimizing CJR performance was just the foundation. Looking ahead, the health system is planning to explore opportunities to negotiate commercial value-based payment programs with Clarify.

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