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Tools for Health Plans and Practice Owners

The ACORN Toolkit includes features of particular interest to practice owners, health plans, business groups and other payers/referral sources.

Marketing and negotiation

The Toolkit permits practices and organizations to collect data across multiple clinicians at multiple sites. Practices are able to aggregate their results for any given time period, and compare their results to external benchmarks. The outcome data empowers practices to make a compelling case for the value of their services, based to measured outcomes and external validation.

The Center for Clinical Informatics provides ongoing consultation to practices in support of using outcome data to market services.


CompareResultsAndMarketing.jpg

Understanding costs

The Toolkit includes algorithms for analyzing claims data, estimating cost per case, and applying sophisticated case mix adjustment calculations. The results can be viewed via the Toolkit Claims Report, which provides case level information on the actual cost per case compared a benchmark defined as the expected cost based on the case mix adjustment model.

The following graph compares actual average cost per case to the benchmark, expected cost per case, for a sample of providers. Note: While the data is representative of real world data, this graph is based on demo data where ID numbers and dollar amounts have been modified for demonstration purposes. These results should not be interpreted as representative of results for any particular health plan or payer.
CostPerCase.png

Resource Optimization (Value)

The Toolkit offers clinical messages based on algorithms developed as part of the Resource Optimization Initiative (ROI). The ROI decision support tools are designed to support clinical decisions at the individual case level. The algorithms are designed to improve outcomes for at risk cases by increasing the intensity and/or duration of care, while at the same time identifying cases with very good outcomes who are not expected to show measurable benefit with further treatment.

The algorithms identify at risk cases, alerting clinicians to such risk indicators such as substance abuse, suicidal ideation, worsening of symptoms and possible problems in the therapeutic alliance. In these cases, the clinician is urged to take steps to assure that the patient remains engaged in treatment. Below is a sample message generated by the Toolkit algorithms.
  • Sample Risk Message
    SampleRiskMessage.jpg

The ROI tools also draw attention to cases with very good outcomes and an absence of any other risk indicators. In these cases, the messages suggest decreasing the frequency of services or termination of care.

  • Sample Good Outcome Message
    GoodOutcomeMessage.jpg

The net result of the algorithms is to shift costs toward patients with severe symptoms who are likely to benefit from further care while reducing costs for patients reporting low levels of symptoms. This results in improved value, meaning that for equal on even reduced cost per case, the average improvement per case is significantly increased.

Resource optimization is of particular importance to clinicians and practices with a mandate to provide services to as many patients as possible within a fixed or limited budget, such a non-profit organizations or practices providing services through capitation or case rate agreements.

Demonstrating value is also critical when negotiating payment rates. High value providers are able to negotiate a higher rate by unit of services by demonstrating the value of their services. Also, it is often the case that providers with excellent outcomes actually have a lower average cost per case, thus providing more compelling evidence for improved reimbursement.

-- JebBrown - 19 Aug 2013

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