Caradigm Solutions for ACOs

Targeted Solutions for Medicare Accountable Care Organizations

What is an ACO?

Accountable care organizations (ACOs) provide coordinated, high-quality care at lower costs to a defined population of patients. These patients, as members of the ACO, will have better control over their healthcare, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers. When an ACO succeeds in delivering high-quality care and managing utilization, it shares in the savings it achieves.

 

Needs and Challenges

In order to maximize earnings under the Medicare Shared Saving Program (MSSP) or other programs offered by the Centers for Medicare & Medicaid Services (CMS), ACOs demand IT solutions to manage the clinical and financial risk within their assigned population. These solutions need to be:

  • Configurable to meet specific customer needs
  • Implemented quickly to achieve rapid time to value
  • Delivered by a company with deep experience in population health and value-based care

Having worked with a number of organizations that have joined or plan to join an ACO, Caradigm understands the specific challenges they face. These challenges include:

  • Understanding risk in the assigned population to identify patients that would benefit from care management or patient outreach
  • Identifying high-risk, high-cost patients to intervene and improve clinical outcomes and reduce unnecessary or preventable utilization of services
  • Integrating data from all systems in the ACO to coordinate and manage care across the community of providers
  • Scaling care management activities to deliver that care more efficiently and consistently across a large population

 

Caradigm Solutions for ACOs

Caradigm offers a suite of solutions targeted at Medicare ACOs; the packages are developed to help ACOs manage populations and achieve shared savings, while being offered at price levels appropriate to each ACO’s stage of development.

Three opportunities exist for you to engage patients for better results.

Caradigm® Risk Stratification ACO

Caradigm Risk Stratification ACO stratifies an assigned population of patients using a standard CCLF feed from CMS to compute multi-factorial risk. Organizations can take preventive action on the identified high-risk, high-cost patient by referring them into care management programs or outreach campaigns to drive the patients towards better outcomes.

 

Caradigm Risk Stratification ACO solution helps Medicare ACOs:

  • Quickly understand the clinical and financial risk in their assigned population by leveraging a single data feed, multiple risk indicators and Caradigm’s rapid implementation process.
  • Take proactive interventions on high-risk, high-cost patients as a means of improving their clinical outcomes, overall health and patient experience, as well as reduce unnecessary or preventable utilization of services.
  • Appropriately allocate care management resources by identifying the patients most in need of those resources.
  • Maximize quality scores by identifying the high-risk patients that demand clinical attention.
  • Earn shared savings by identifying potentially high-cost patients early enough to take preventive measures.

Caradigm® Stratification & Analytics ACO

Caradigm Stratification & Analytics ACO stratifies an assigned population of patients using a standard CCLF feed from CMS to compute multi-factorial risk, as well as tracks utilization patterns by patients and providers. As a result, organizations can take preventive actions to drive the patients toward better clinical and financial outcomes.

 

Caradigm Stratification & Analytics ACO solution helps Medicare ACOs:

  • Quickly understand the clinical and financial risk in their assigned population by leveraging a single data feed, multiple risk indicators and Caradigm’s rapid implementation process.
  • Take proactive interventions on high-risk, high-cost patients as a means of improving their clinical outcomes, overall health and patient experience, as well as reduce unnecessary or preventable utilization of services.
  • Reveal utilization and financial trends and drilldown to perform a detailed analysis.
  • Compare current cost and utilization to benchmark and internal targets.
  • Reduce out-of-network utilization and increase in-network steerage.
  • Appropriately allocate care management resources by identifying the patients most in need of those resources.
  • Maximize quality scores by identifying the high-risk patients that demand clinical attention.
  • Earn shared savings by identifying potentially high-cost patients early enough to take preventive measures.

Caradigm® Care Management ACO

Caradigm Care Management ACO enables comprehensive, effective management at a population level and seamless coordination for individual patients. The solution can accept population data to identify new candidates for program enrollment, enable identification and mitigation of potential gaps in care, and enable the consistent delivery of evidence-based care.

 

Caradigm Care Management ACO solution helps Medicare ACOs:

  • Quickly understand the clinical and financial risk in their assigned population by leveraging a single data feed, multiple risk indicators and Caradigm’s rapid implementation process.
  • Take proactive interventions on high-risk, high-cost patients as a means of improving their clinical outcomes, overall health and patient experience, as well as reduce unnecessary or preventable utilization of services.
  • Appropriately allocate care management resources by identifying the patients most in need of those resources.
  • Maximize quality scores by identifying the high-risk patients that demand clinical attention.
  • Earn shared savings by identifying potentially high-cost patients early enough to take preventive measures.
  • Manage risk, care quality and financial results—by focusing on the most-costly patients—across the continuum of care.
  • Streamline management of patient populations to enable more consistent use of evidence based medicine and sharing of best practices across care teams.
  • Aggregate clinical, operational and financial data, near real-time analytics and care pathways based upon industry standard clinical protocols.