October 11 2019

Solution Brief: Total Cost of Care Insights

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Understand performance across the full continuum of care and pinpoint high-impact improvement opportunities


1. Comprehensive diagnostic assessment for each of your provider partners across 3 performance lenses:
Total Cost of Care: benchmark Primary Care and Specialty utilization, cost, and quality against AI-created “expected values” across 20+ areas

Acute Care: true “inside-the-DRG” look at spend to optimize both cost efficiency and care efficacy during an inpatient stay

Post-Acute Care: examine discharge patterns and post-acute care utilization

2. Tailored “Treasure Map” reports that pinpoint actionable performance improvement opportunities at facility, physician, and patient cohort-levels

3. Root cause analysis on unwarranted utilization, cost, and quality variation to drive specific operational change


– Higher-quality care delivery and direct bottom-line impact through identification of specific opportunities and complementary root cause analysis to cross the chasm from insight to action
– Total cost of care improvement of just 12% could result in $120M of savings

Case Study:

Customer situation
– Multi-hospital system in NJ, middle-of-the-pack performer on quality
– Interested in case-mix adjusted performance analytics by hospital/ episode/ physician to understand where they bring differentiated value to market and where to focus improvement efforts

Clarify approach
– Sized total opportunity across post-acute and total cost of care using case-mix adjusted benchmarks
– Created “treasure maps” to pinpoint actionable, high-impact performance improvement opportunity at system, hospital, and physician levels
– Facilitated extensive discussions to answer questions, and provide expert perspective on change management

Why Clarify:

– Case-mix adjustment built by docs, for docs, with transparency tools so they can “look under the hood” and see and believe for themselves
– Integration of your claims, clinical, and purchased data assets into Clarify’s comprehensive data set including 100% Medicare claims, commercial and Medicaid claims on 110M+ lives, clinical data, and social determinants
– Automated generation of tailored reports to get easy-to-digest information and visualizations to stakeholders at the right level of granularity

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