Essential Tools for Population Health & Capitated Payments

Unlike past CMS Accountable Care Organization models, ACO REACH uses risk-adjusted capitation as the payment mechanism and requires organizations to collect and analyze health equity metrics to improve care and access for underserved populations.

As prospective REACH ACOs prepare for launch, many are struggling to find payment technology that seamlessly integrates capitation claims processing with analytics to uncover critical insights about contract performance, funds flow, and profitability.

Watch as Greg Caressi from Frost & Sullivan discusses the specific tools that ACO REACH organizations will need to effectively improve population health in this new program.

All ACOs need tools that provide:

• Data management to pull together multiple pieces of information from disparate data sources
• Analytics to improve risk stratifications for all patients
• Care management to improve coordination and engage patients in their care needs

But REACH ACOs need additional tools that go beyond the ability to manage upside or downside risk. They also need:

• Tools to help with contract and provider performance management on both the clinical and financial side
• Insights into the funds flow and patient care that are as close to real-time as possible, particularly for capitated care models
• An advanced software platform that can identify and carry out a health equity plan, as well as collect social determinants of health (SDoH) data from aligned beneficiaries
• An integrated data lake that eliminates conflicting information from disparate sources and serves as a source of truth for analytics, care management, and capitation claims processing

Another critical shift coming with ACO REACH is the necessary change in organizational attitudes to address health equity. Succeeding in this new model will require more than just an IT software program. Providers and payers will need to examine organizational structures and cultures to deliver what patients need. That requires a partner with a track record of success enabling value-based care delivery and payment, including current GPDC participants preparing for their first year of ACO REACH.

Many ACOs know they need these capabilities, but their current software partners lack an integrated platform that links capitation payment technology, and care management, with powerful analytics and data management. Learn more about Cedar Gate’s end-to-end solution that enables organizations to succeed in this new model by contacting us today.