Session ID: 
117

UHS Case Study: ACO Data Driving Network Adherence

10:00am - 11:00am Wednesday, March 11
Orlando - Orange County Convention Center
W204A

Description

Inpatient stays represent roughly 31% of the annual expenditure for a MSSP ACO beneficiary, not taking into account post-acute care scenarios. Variability in coordination of care can result in dramatic variation in cost during and after these high cost events. Primary Care Providers in the MSSP program are held accountable for all of this spend, but lack visibility into the patient’s longitudinal record to take the steps necessary to minimize cost and improve outcomes. In this session we will share a case study of how Universal Health Services (UHS) was able to accomplish better care coordination by having the PCP involved as part of the overall episode of care and leveraging ACO claims data to target a decision point that providers could impact: the selection of a high quality facility for elective procedures. Empowering the PCP to understand the decision points, the decision makers and ultimately the impact of the decision will give them the visibility to change the things we are already holding them accountable for.

Learning Objectives

  • Analyze and track the referral patterns of in-network providers
  • Calculate the financial impact of leakage on hospital revenues and care coordination
  • Assess the opportunity to improve referral management and resource allocation

Speaker(s)

Director, Product Management,
CareJourney
ACO Operations Director,
Prominence Health Plan

Continuing Education Credits

CAHIMS
1.00
CME
1.00
CNE
1.00
CPHIMS
1.00
IAPP
1.00

Audience

CISO/CSO
Healthcare Financial Professionals
Physician or Physician’s Assistant

Level

Introductory