Outcomes-Based Contracting, Payment Integrity Among Highlights of SCIO Health Analytics' Top 5 Blog Posts of Second Quarter 2018 View as PDF

SCIO’s Analytics Experts Provide Insights on Population Health, Data Mining and Risk Adjustment

WEST HARTFORD, Conn., July 31, 2018 – SCIO Health Analytics® today announced the Top 5 most-read posts on its blog, SCIOKnow, for the second quarter of 2018. The blog provides actionable insights on how healthcare organizations (HCOs) can unleash the power of data to empower decision-makers to make the choices that drive measurable outcomes improvement.

In the posts below, SCIO’s analytics experts share their knowledge on a broad variety of topics, including: the barriers that are preventing HCOs from determining the total cost of care they provide; how HCOs can successfully manage additional risk; the top challenges payers and life sciences companies face in managing outcomes-based contracts; why payers must innovate to meet the ever-expanding challenges of payment integrity; and the importance of integrating custom concept development into data-mining programs for payment integrity.

1. HealthLeaders Buzz Survey Results: Data Challenges Stand in the Way of Managing Care Costs: A survey of 142 healthcare leaders conducted by HealthLeaders Media and sponsored by SCIO Health Analytics concluded that a lack of data on the true cost of care is standing in the way of sustainable cost reduction efforts. The survey results shed light on what types of data are not accessible; the challenges that are preventing greater transparency; and how organizations are struggling to more effectively leverage data analytics. This post examines results from the survey, including key roadblocks that must be overcome before HCOs can arrive at a more complete understanding of costs.

2. Risky Business: Three Key Levers to Successfully Manage Your Risk: The pace toward value-based care delivery and contracting is quickening and gaining momentum at an increasing rate. As HCOs grapple with this transition, perhaps the greatest challenge they face is to ensure they stand on solid ground when looking to assume and manage additional risk across their organizations. In this post, Rose Higgins, president, North America, details three key steps organizations should take to properly manage risk-based arrangements.

3. Poll Results: Ready to Embrace Outcomes-Based Contracts? During a webinar on outcomes-based contracts between payer organizations and pharmaceutical companies, participants provided insight into how far along their organizations have progressed with the actual use of these contracts. This post summarizes poll results from the webinar that illustrate some of the top challenges associated with successfully implementing and monitoring the performance of outcomes-based contracts.

4. Looking to Advance Your Payment Integrity Journey? Time to Embrace Innovation: With healthcare costs, aging populations, patients with chronic conditions and overbilling schemes all on the rise, payment integrity is more important than ever. Consequently, payers must ensure that they have payment integrity basics down – while also striving to implement audit innovations that deliver benefits more expediently with reduced administrative burden and greater success. In this post, Monique Pierce, vice president of business optimization, and Leslie Strader, project manager, describe new approaches to enhancing payment integrity, including prepayment audits and behavior modification programs.

5. Custom concept development: The key to overpayment recovery ROI: For health insurers, the consequences of over- or under-paying a claim can include provider abrasion, wasted spending and investment in resources to recoup excess payments. Due to its potential for automation and low provider abrasion, data mining is an appealing option for addressing payment integrity, but these programs have historically been plagued by a tendency to return false positives or responses that aren’t actionable. This post by Lalithya Yerramilli, vice president of analytics, explains why plans whose data-mining programs integrate custom concept development can achieve far more accurate results and a more favorable ROI.

SCIO Health Analytics’ blog, SCIOKnow, covers all things related to healthcare data analytics solutions and services. The blog publishes on a weekly basis and features approximately a dozen authors who are subject matter experts in a broad array of topics, including population health, payment integrity, risk-adjustment, care management, opportunity analysis and incentive design, consumer segmentation and engagement, network performance and commercial effectiveness. To view the Top 5 posts on SCIOKnow from the first quarter of 2018, please click here.

Media contact:
Brandon Glenn
Amendola Communications

SCIO Health Analytics Contact:
Michele Norton, M.S., R.N.
Senior Vice President Marketing