BUNDLED PAYMENTS FOR CARE IMPROVEMENT
BPCI Advanced is one of the more difficult Advanced Alternative Payment Model programs to manage performance under. Not only did CMS step up their game on case-mix adjustment, but the clinical episodes are more complex, and the program takes into account peer performance. Unfortunately, many participants won’t have visibility into the data driving these factors until it’s too late.
Where BPCI-Classic case-mix adjustment was based on the DRG, BPCI Advanced uses more than 100 factors, including demographics, DRG, HCC severity, AMC status, and recent resource use, to adjust for patient complexity.
Additionally, unlike previous programs that calculated a DRG-level target price, BPCI Advanced target prices are assigned on a patient-by-patient basis, based on the presentation factors of each individual patient receiving care.
The target price you receive from CMS is based on your historical patient population and in effect, retrospective. The actual target price of a patient who presents on admission could be vastly different. Without the ability to replicate CMS’s methodology for target pricing, you’re essentially flying blind.
BPCI ADVANCED STRATEGIC DECISIONS SUPPORT
Selecting which episodes to pursue requires precision. Performance in the BPCI program is based on improvement against a shifting baseline and target price.
Clarify goes beyond the traditional approach of assessing opportunity based largely on episode volume, unadjusted benchmarking and linear calculation of upside potential. Our customers receive the full power of our advanced statistical modeling and machine learning platform which runs on data covering over 90 million CMS and 60 million commercial beneficiaries.
COMPLETE DIAGNOSTIC ASSESSMENT
Analysis of provider and market data to inform likely performance and recommended episode participation, drawing on Clarify’s proprietary dataset
PERFORMANCE & CHANGE MANAGEMENT
Identification of specific areas for improvement using case-mix adjusted analysis and clinical transformation support
PATIENT IDENTIFICATION & STRATIFICATION
Prediction of BPCI-A eligibility upon hospital admission and initial risk stratification to inform optimal care delivery
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What sets us apart:
CREDIBILITY AND EXPERIENCE
Recognized for offering the most comprehensive solution on the market, Clarify is ranked the #1 bundle solution across eight functional categories (e.g., opportunity analysis, cost reporting). Our partners trust that Clarify offers the best solution in the market to enable success in bundled payments.
CMS QUALIFIED ENTITY
We are one of a handful of organizations with 100% of identified Medicare claims data across 5+ years. Directly sourcing in your data from CMS and augmenting it with our own proprietary dataset including EMR, demographic, social behavioral determinants of health data, we are able to return more timely and actionable insights.
CLARIFY “EXPECTED” VALUES
Building on this extensive dataset, we apply advanced statistical modeling and machine learning techniques commonly used in industries outside of healthcare (like financial services) to healthcare data to return precise case-mix adjusted analyses at the patient, physician, and hospital level. Much like baseball’s Wins Above Replacement analytics, Clarify Expected Values, illuminate clinical and financial variation on a case-mix adjusted basis. Our platform provides dynamic performance insights on apples-to-apples comparisons that physicians trust.
We support our partners through all aspects of bundle management. We’re there from the first CMS announcement and application window to enrollment decisions, pre-program preparations, go-live, and beyond.
BETTER BUNDLE CHOICES
Far more rapid and precise analytics enables better bundle choices. Make an educated enrollment decision by targeting which episodes make sense based on projected performance.
Tackle opportunities for improvement by identifying areas of unwarranted financial and clinical performance variation
HIGHER QUALITY AND BETTER OUTCOMES
Care Prism delivers precise information on which types of patients need greater focus along a host of quality metrics, including readmissions and mortality. Automatically forecast the impact of quality on your finances and prepare for the program launch by understanding where to invest early in care redesign and clinical behavior change.
REAL CHANGE AND LEARNING
Actionable insights lead to collaborative conversations between care teams to standardize best practices and make timely updates to practice patterns. Physicians end up leading the shift to value, knowing they can trust the data.
Track financial performance by comparing spend to Clarify-predicted target price for each patient as they receive care. By closely managing performance on a granular level and in real-time, our customers deliver more effective and efficient care, thereby ending up on the right side of the risk equation.
STRATEGIC AND MARKET INTELLIGENCE
Instantly leverage Clarify’s 150m+ lives database to pinpoint your performance, strengths, and weaknesses. Use this knowledge to your power better strategic decisions and negotiations.