Clinical Analytics for Finance

Sophisticated risk-adjustment and clinical analytics in partnership with EPSi

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Clinical Risk-Adjustment

CFOs and their teams are generally forced to interpret and act on cost data that is not properly adjusted for the influence of case severity and complexity. Care of higher risk patients frequently requires more resources, invalidating direct comparisons of cost and resource utilization. Our cutting-edge clinical risk-adjustment of cost data permits apples-to-apples comparisons and allows you to make the right decisions for the right reasons.

Cost-Efficiency

Adverse outcomes alter the course of care, influencing costs and utilization in unanticipated ways. It is difficult to accurately separate costs associated with the care of adverse outcomes from costs associated with routine care. As a result, finance teams face challenges in identifying those costs and utilization that can be effectively managed through administrative controls and oversight. Our technique for objectively identifying “routine” cases facilitates accurate analyses of cost-efficiency and permits targeted cost management efforts that achieve meaningful results.

The Cost of Quality

Traditionally, it has been very difficult to evaluate the financial implications of differences in clinical quality. The rate at which adverse outcomes occur and the severity of the adverse outcomes when they occur may have a significant impact on costs. Our powerful method of converting quality onto a dollar scale informs decisions about hospital quality initiatives and guides conversations with CMOs and their teams.

Signal vs Noise

It can be difficult to tell, when tracking performance over time, whether changes are real or simply the result of random variation. Our integration of risk-adjustment and control charts permits early identification of changes in process that merit attention and ensures that resources are dedicated to legitimate issues.

Components of Change

When comparing financial performance over time, CFOs and their teams often lack the ability to cleanly identify the drivers of observed differences. Combining our risk-adjustment and analytic methods, variation can be broken into three key components: shifts in case mix, changes in acquisition costs, and changes in utilization. Proper attribution of responsibility for variation focuses initiatives to manage costs and improve efficiency.

Physician Incentives and Alignment

Hospitals depend on physicians to efficiently manage resources while maintaining or improving the overall outcomes of care. Unfortunately, it is difficult to control physician behavior and poorly designed incentive systems may have adverse financial consequences. Our analytic framework supports a flexible, non-directive structure that effectively enables hospitals to reward physicians, whether employed or independent, for their contributions to the bottom line while intrinsically penalizing decisions that jeopardize quality.

find us at Visis: 2018 EPSi Summit October 10 – 12, 2018 Learn More