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Provider Networks Can Make or Break ACO Success in VBC

BLOG | July 13, 2023

CGT_VBCA

As healthcare shifts from volume-based to value-based care, success depends at least partly on your ability to build a network of care partners that have the same focus on lowering costs, improving care quality, and increasing patient satisfaction. Accountable Care Organizations (ACOs) need advanced analytics tools to identify high-performing providers who can help optimize savings and enhance care coordination.

Cedar Gate’s Value-Based Care Analytics platform gives you valuable insights to identify the right providers for your network and maximize savings opportunities.

ALIGNING NETWORKS FOR VALUE-BASED CARE

In the past, many provider referral networks were based on interpersonal relationships or past experience – that is, providers from various specialties would reach out and make connections with one another, establishing a pattern to refer patients to each other as needed. Providers would send referrals to clinics or doctors they trusted to take good care of a patient. But few referring providers had insights into the actual quality outcomes or the cost of care when a patient went to these other providers.

Value-based care success now requires organizations to understand key performance metrics for the providers in their network to achieve “Triple Aim” goals: cost, quality, and patient satisfaction. The ability to spot high-performing providers is essential to building referral networks for participation in risk-based contracts.

Identifying Top Performers in Quality and Cost

Cedar Gate leverages client-provided data and then applies comprehensive analytics to identify top-performing providers within a particular market. Our Value-Based Care Analytics software uses measures to define top-performing providers that include:

  • Benchmarking using local, regional, or national data
  • Peer-to-peer comparisons
  • Quality metric achievement comparisons
  • Risk-adjusted population cohort comparisons
  • Total cost-of-care (professional, acute, post-acute, and ancillary services)
The Importance of Forward-Looking Analytics

While many analytics tools give users the ability to see past performance, not all of them make it possible to project provider performance into the future. That forward-looking ability in an analytics platform is critical to success for ACOs, particularly as more organizations are entering into downside-risk contracts. Past performance is one indicator of future success, but it’s not the only data point you should be examining.

Cedar Gate’s proprietary algorithm calculates expected cost and utilization performance and compares the results to actual performance. That gives you the power to identify savings opportunities by finding providers whose actual performance is above the mean performance across the comparison cohort.

GAINING VISIBILITY INTO PROVIDER-LEVEL UTILIZATION METRICS

Cedar Gate’s Value-Based Care Analytics platform offers data analysis specific to any value-based care program in which a provider and their patients participate. For example:

  • Contract-specific utilization measures
  • Comparisons to other providers serving the same members
  • Patient-level utilization data for additional insights into health management

By leveraging this information, organizations can optimize their networks, identify top-performing providers, and ensure the delivery of high-quality, cost-effective care.

HEALTHCARE’S FUTURE REQUIRES DATA-DRIVEN DECISION MAKING

The healthcare industry is evolving rapidly, and organizations must be agile and data-driven to stay competitive. Cedar Gate’s Value-Based Care Analytics platform is an indispensable tool for ACOs ready to embrace this shift, supporting informed decision-making that makes it possible to save money while providing better quality care and improving patient satisfaction.

Embrace the future of healthcare with Cedar Gate’s Value-Based Care Analytics platform. Learn more about the benefits it can offer you.

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