Is Your ACO REACH Organization Still Using Spreadsheets to Track Payments?

Accountable care organizations participating in the Realizing Equity, Access, and Community Health (ACO REACH) program have an incredible amount of data. Making sense of information on beneficiaries, claims, and provider contracts can become really complicated. Many organizations participating in ACO REACH have limited tools to track this information, and have to rely on spreadsheets to keep it all straight. This creates a large amount of manual work to understand a rapidly evolving landscape of aligned beneficiaries, quality metrics, and reimbursements.

MANUAL DATA TRACKING LEADS TO DELAYS, ERRORS, & FRUSTRATION

Excel is a great tool for tracking simple datasets, but the level of complexity and frequent changes in ACO REACH datasets make them virtually impossible to track manually using spreadsheets. Some of the most common challenges organizations encounter when they don’t have the right software to manage capitated payments for a large ACO population include:

• Data errors: ACO REACH data on claims, capitated payments, and aligned beneficiaries must be up to date at all times. When staff must manually update the information, it’s prone to human errors that could result in over- or underpayment – something that is difficult to detect until much later and can lead to unexpected costs or missed revenue when you finally discover the error.
• Processing delays: A lack of tools to automate capitated payment processes puts pressure on an already stressed workforce, who now must manually keep information up to date in time-consuming and often frustrating workflows. Delays that impact revenue can be costly in a capitated payment model.
• Scalability issues: Organizations participating in ACO REACH may want to scale up, establishing multiple TINs to pursue new business opportunities. The increasing complexity and scale of work can put plans to expand on hold with limited staff time to complete the work.
• Limited reporting and analytics capabilities: Advanced analytics and automated reports can help ACOs make strategic decisions for the future. Generating insights from complex data sets, such as predicting costs or analyzing provider performance, can be cumbersome and time-consuming in applications like Excel. These spreadsheet programs often have limited capabilities, increasing the reliance on costly actuarial consulting arrangements.

THE SOLUTION: AUTOMATED, STREAMLINED CAPITATION SOFTWARE

Cedar Gate’s Capitation Adjudication software is specifically designed to handle the complexity of capitated payment arrangements. Organizations can save time, improve accuracy, and reduce payment errors with a composable solution that meets the needs of ACOs of all shapes and sizes participating in the REACH program.

Save time, improve accuracy, and reduce payment errors. Eligibility management software streamlines the process of keeping track of your eligible beneficiaries. Cedar Gate’s tools ingest standard and non-standard eligibility rosters and automatically matches members to PCPs or specialists (with the ability to reassign patients during contract periods). Plus, it provides a clear audit trail for simple reporting.

Eliminate the complexity of managing multiple provider contracts and fee schedules. Manage all your provider contracts and fee schedules in a single platform, add specific criteria and rules to each based on your contracts, and integrate fee schedules from CMS and commercial payers, as well as external pricing engines. Data interfaces ensure that everyone in your partner ecosystem has relevant information for better transparency.

Validate payment amounts with reconciliation tools. Reconcile expected payments with actuals with software to ensure claims and payment accuracy prior to sending out reimbursements. Billing teams can easily identify anomalies or exceptions and intervene, saving time by not having to comb through every claim and payment file to find errors.

Automate authorizations and referrals. Cedar Gate’s tools automatically match members with an assigned primary or specialty care provider. Configure workflows to automate and track common referrals and authorizations – including denials, appeals, and reviews. Automated letter creation tools ensure compliance, all while removing burdensome and time-consuming administrative tasks from busy team members. 

Scale operations to support multiple ACO REACH lines of business on a single payment platform. When you’re ready to expand and reach more beneficiaries by establishing new ACOs, Cedar Gate helps you quickly scale up and add new lines of business. Use existing configurations to establish new ACOs, then customize as needed based on unique program parameters.

Directly connect your data from a core administration system for real-time analysis. Advanced analytics are at the heart of ACO REACH success. Cedar Gate’s proprietary data management system pulls together information from dozens of sources, normalizes, and enriches the data, then stitches it to each member so you get the full picture of what each patient needs. Our capitation solutions are part of a composable and fully integrated system that shares a common data lake, so every piece of information is available throughout your applications, and continually updated and refreshed for accuracy and ease of use.

START BUILDING YOUR ACO REACH TECH STACK

Discover why dozens of ACO REACH participants are working with Cedar Gate to build a composable tech stack that aligns clinical and financial goals to improve performance. Start creating your ideal solution today.