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CST: 24/08/2019 18:00:39   

Healthcare Leaders Back Analytics Software That Overcomes Major Barrier to Value-Based Care

114 Days ago

NEW YORK, May 02, 2019 (GLOBE NEWSWIRE) -- COPE Health Solutions, Montefiore Health System, Adventist Health, and Heritage Provider Network Inc. have formed a joint venture to introduce an analytics software platform. Analytics for Risk Contracting (ARC) software enables healthcare providers to determine their actual care costs and understand the net financial effect of specific care improvement efforts, population health management and other quality and cost initiatives.

“Within two weeks of using ARC, we identified several large opportunities for improvement. We prioritized the most pressing ones and have begun the process to revise hospital contracts to generate annual savings going forward,” said John Beaman, Chief Business Officer for Adventist Health.

The ARC software suite overcomes the enormous challenge facing many providers in understanding their total cost of care and the expense breakdown for providing particular treatments or caring for specific patient groups. Health systems, physician groups and other healthcare providers often lack necessary operating information because under the fee-for-service system, payments have long been disconnected from costs.

“Not understanding the actual total cost of care, in detail, is a huge obstacle to moving U.S. healthcare to value-based care and risk-based payments,” said Yomi Ajao, the COPE Health Solutions senior vice president who led the development of the ARC software tool and will serve as president of the joint venture, Analytics for Risk Contracting, LLC. “The tremendous promise of value-based care won’t be realized unless providers can see their way forward to accepting more reimbursements tied to cost and quality goals. ARC solves this fundamental problem.”

More firepower
ARC uses proprietary algorithms for financial modeling that enable providers to understand and explore the net financial effect of various combinations of inputs, such as changes in specialty use, inpatient use, and physician incentives. Providers can see how they are performing against their care delivery and financial plans.

“Using its years of population health management experience and ARC, Montefiore’s Care Management company found opportunities to reduce single-day admissions, admissions for end stage renal disease, improve in-network referral, and reduce overall cost of specialty care,” said Stephen Rosenthal, President, Care Management Company, a subsidiary of Montefiore Health System.

Montefiore has been a pioneer in population health management and value-based purchasing for more than two decades. Through its Care Management Organization, it administers comprehensive care to close to 500,000 Medicare and Medicaid beneficiaries, and members of commercial health plans.   

“ARC software is a breakthrough for advancing value-based care. It gives physicians, health systems and other providers, the ability to transform their health plan contracting from volume to value. We continue to see CMS’ movement away from fee-for-service, most recently through the newly announced Direct Contracting Payment Models, and ARC can help medical groups, IPAs, ACOs and others considering these demonstrations,” said Richard Merkin, MD, Founder and CEO of Heritage Provider Network, the nation's largest physician-founded, global risk-managed organization. 

Going beyond other total cost of care tools, ARC software delivers precise information and detailed insight because of its analytical power and more comprehensive data sources. ARC:

  • Aggregates data from numerous sources across the continuum of care and populations—claims, pharmaceutical, provider financials, and national, regional and network benchmarks.
  • Identifies problems or variations within populations, service lines, clinicians or locations, such as avoidable utilization.
  • Provides root causes and paths for navigating to solutions.

Working with ARC
Montefiore Health System and Adventist Health have been strategic partners with COPE Health Solutions, a population health management consulting firm, in developing and using the cloud-native ARC tool. They have teamed up with Heritage Provider Network to form a subsidiary of COPE Health Solutions to make the tool available as a software as a service platform. Clients also have the option of working with COPE Health Solutions to analyze data, develop insights, understand the financial consequences and plan and execute improvement efforts.

About COPE Health Solutions
COPE Health Solutions is a national health care business advisory firm and a leader in moving health care payers and providers to value-based payments and care models. It partners with clients to help them achieve visionary, market relevant health solutions. COPE Health Solutions’ areas of expertise and focus include all aspects of strategy, population health management, value-based payment, data analytics, and workforce development for clients across the health care continuum, including hospitals, health systems, physician organizations, and health plans.

COPE Health Solutions’ multidisciplinary team of health care experts provides clients with the experience, capabilities and tools needed to plan for, design, implement and support both the development and execution of strategy. The firm partners with clients through aligned mission and financial incentives to pursue performance excellence in a challenging and rapidly evolving health care environment. For more information, visit www.copehealthsolutions.com.

About Montefiore Health System
Montefiore Health System is one of New York's premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 11 hospitals, including the Children's Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its' medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its' preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.

About Adventist Health
Adventist Health is a faith-based, nonprofit integrated health system serving more than 80 communities on the West Coast and Hawaii. Founded on Seventh-day Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care agencies, hospice agencies and joint-venture retirement centers in both rural and urban communities. Our compassionate and talented team of 37,000 includes associates, medical staff physicians, allied health professionals and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. Together, we are transforming the American healthcare experience with an innovative, yet timeless, whole-person focus on physical, mental, spiritual and social healing.

About Heritage Provider Network 
Heritage Provider Network, Inc. (HPN) is one of the most experienced physician organization leaders of accountable care and continuous value-based healthcare delivery improvements. Developing and managing coordinated, patient-doctor centric, integrated health care systems that offer some of the strongest solutions for the future of health, care and cost in the United States. HPN and its affiliates operate in New York, California, Arizona, Missouri and Colorado providing high quality, cost effective healthcare with over one million patient members and are dedicated to quality, affordable health care, and putting patients' wellness first. www.heritageprovidernetwork.com

Media contacts:
Sarita Choy
COPE Health Solutions
schoy@copehealthsolutions.com
(323) 270-5895

Janet Janjigian
Heritage Provider Network
janjigianj@carmengroup.com
(424) 354-0133

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