A patient’s use of a in-network or “preferred” group of providers can have a large impact on ACO performance. A preferred network can be based on quality and cost performance, ownership, or another type of affiliation. Regardless of how the network is defined, tracking and managing the compliance with this network is an important component of any ACO.
Network optimization allows attributed physicians a better line of sight to utilization and outcomes for their populations. This enables the overall network to perform more effectively at cost containment (savings, utilization, etc) while improving the health of their populations.
Such was the case with one of our ACO clients that has designated a set of acute care facilities with which they have preferred terms. With Koan Health’s analytics, they track the usage of out-of-network facilities for patients seeking surgical care. They knew some patients were seeking surgical care and wanted to get a better understanding.
In particular, they wanted to get at the root of why that was happening. Why are patients motivated to seek care outside of their network for specific types of surgeries? Who is performing them? Who is the patient’s primary care provider?
They were able to pinpoint two large drivers of out-of-network use. The first is location. In some cases, there simply aren’t the right providers or facilities nearby, so patients opt for a location that is closer to home and more convenient. Second, attributed providers may drive patients out of the network through referrals.
ACOs can optimize their networks and close leakage by having simple conversations based on data with the attributed providers and providing them with tools to address patterns of referrals and keep care within the network. Regarding location, it may be an issue of future planning to address access issues by providing services or facilities in areas that may be underserved by the network. These, of course, are simple answers, but they give you an idea of how to begin to address the issue.
Network management is just one example of how Koan Health analytics can provide actionable insights to help ACOs achieve financial transformation. Knowing where to start is half the battle.