ACO SOLUTIONS

 

ACO's face multiple challenges related to the assumption and management of risk as well as managing the quality of care needed for successful outcomes. Meeting these challenges requires unique expertise related to data acquisition and management, data analytics and reporting, budget management, contracting and network management, quality management and reporting, provider management and incentives, revenue maximization and care coordination. hMetrix provides this expertise along with a tool suite designed to successfully meet these challenges.

UNDERSTANDING AND MANAGING BUDGETS

To successfully share risk with organizations like CMS and payers, ACOs require solutions to understand and manage their budgets. The first step in this multifaceted process of managing an ACO is acquiring, validating and understanding the budget and the data used to build it.

Features:

  • hMetrix has the expertise to acquire, clean and integrate the databases that have been used to develop an ACO's budget. Using this data in its ACO management solution, hMetrix can validate and audit the payer's budget development processes
  • This solution is used to audit costs through data updates as a mechanism to monitor the effectiveness of the ACO's management process and provides meaningful reports to all the different disciplines on the ACO's management team

Performance Management

In order to successfully manage risk, ACO's need to align providers with the objectives of the ACO. This includes utilization, in-network referral and quality management objectives.

Features:

  • Negotiate contracts with providers that establish prospective goals for the contract period
  • Track performance and produce score cards for providers
  • Compute incentives at the end of each performance period that rewards the provider for their performance

Patient Monitoring

Migration to value-based and shared financial risk payment structures have predicated a need for ACOs to proactively monitor members. hMetrix offers a set of standard tools to help ACOs with monitoring activities. These standard tools can be enhanced to offer a more customized solution based on an ACO's specific need.

Features:

  • hMetrix' Dobile solution is a web and tablet based tool used to capture, track and report patient data in the field
  • It has customizable and user-friendly dashboards designed to provide information that is relevant to different members of the management team
  • Patient outcome measures as defined under HEDIS or Star ratings can be incorporated on top of Dobile to maximize performance incentives for providers

CARE COORDINATION AND PATIENT MANAGEMENT

Proactive care coordination and patient management strategies are a critical component of next-generation ACOs. Smart analytics and results oriented tools can help ACOs improve care and reduce costs. ACOs need to have a comprehensive strategy that covers all aspects of care including acute care, post-acute care and home health management that are implemented with proper protocols, technology, training and delivery.

Features:

  • hMetrix has a care management platform that is driven by a unique set of patient assessments
  • hMetrix’ unique assessment information along with other administrative and EMR data integrated into the platform drives an automated patient-centric care plan designed to meet the patient’s unique needs
  • The platform supports patient and family engagement tools .These tablet based apps for monitoring and 24/7 coverage include a nurse call button, video education, and virtual video visits for clinical pharmacy management, behavioral health interventions and biometric monitoring
  • The entire process can enhance provider revenue by qualifying the ACO primary care physicians for CMS care coordination fees