CareJourney unveils the industry’s most comprehensive, explainable, and reliable way to evaluate Cost and Outcomes across PCPs and Specialists
July 31, 2019 — CareJourney, a leading health care analytics company, announced today its latest innovation – the CareJourney Index. Using this breakthrough product, healthcare organizations including Payers, Hospitals, Health Systems, and ACOs are able to measure and score over 950,000 providers, including Primary Care Physicians (PCPs) and Specialists, across dozens of industry-accepted cost and outcome metrics using easy-to-understand Cost and Outcome scores. CareJourney’s approach allows its customers to easily and quickly benchmark providers across specialty and geography such as a Core-Based Statistical Area (CBSA) in minutes, eliminating the months of specialized work and excessive cost required to perform such thorough and rigorous statistical analysis.
There are multiple ways that provider performance has been measured to date, ranging from forums that gather online feedback from patients, to multi-factor frameworks like CMS’ Physician Compare. Additionally, some commercial payers have built their own provider rating systems using in-house claims data. Healthcare data and analytics vendors generally combine multiple provider evaluation metrics into a score for sorting and comparing providers. However, the tools that exist today are either not comprehensive enough or lack transparency, which often leads to a general lack of confidence in these measures and ultimately no or low adoption.
“There are multiple challenges in measuring provider performance in a reliable way,” said CareJourney CEO, Dan Ross. “The lack of an unbiased, complete, timely, and robust dataset to make fair comparisons between providers is the most fundamental issue. To complicate matters further, most rating systems are proprietary, so stakeholders have no way to see or trust the calculations or methodology used. Finally, most ratings systems today make arbitrary simplifications of a complex problem, often conveying harshly as a good-doctor/bad-doctor scale. Our approach to the CareJourney Index addresses these critical challenges.”
The implications of not having a comprehensive, explainable, reliable, and standards-based provider performance score are potentially inaccurate, incomplete, or misleading insights that lead to bad or expensive business decisions.
A Breakthrough in Measuring Provider Performance. No Black Boxes.
Building upon its strong foundation of providing clinically-relevant insights across patients, providers, facilities, and networks, CareJourney developed the CareJourney Index using a comprehensive approach that looks at both cost and outcome metrics derived from patient episodes instead of simply individual treatments or procedures. This facilitates meaningful benchmarks for the more than 950,000 providers who are best positioned to address the majority of the variation in cost or quality in healthcare.
“We are working with our customers to collaboratively design a more open and transparent measurement system,” said Aneesh Chopra, President of CareJourney. “The CareJourney Index synthesizes publicly available performance metrics calculable on claims data to lower the barriers for all organizations involved to succeed in the shift toward value-based care: whether it is a payer trying to build a high performing clinical network; a hospital system trying to improve high priority clinical outcomes; or healthcare consumers via an application they trust to make an informed choice on which provider to pick for an upcoming procedure.”
CareJourney is one of the few companies that has earned access to complete, linked Part A, B and D Medicare fee-for-service and Medicare Advantage encounters data, representing over 80M distinct beneficiaries and 10 billion claims, making for a dataset that rivals or exceeds the coverage of the largest US health insurers. CareJourney’s data access includes 10 years of longitudinal history and growing, as recent as the latest 90-180 days, making the resulting scores as statistically significant and timely as possible.
The Data Science
The CareJourney Index scores PCPs and Specialists on two five-point scales, one for Cost and one for Outcomes, corresponding to quintiles of performance against similar providers in their region. Our approach has unlocked a novel way to leverage already-accepted metrics, building on standard component algorithms for attribution, risk-adjustment, and episode bundling, thereby making them auditable and comprehensive.
One Universal Score, Many Use Cases
The CareJourney Index allows multiple actors in the healthcare industry to compare providers using a universal scoring system.
For Payers: Get an augmented view of provider behavior based on one of the largest national-payer-scale datasets to improve overall understanding of a provider’s practicing patterns, as a supplement to the payer’s own data or in cases where that data does not exist. Evaluate providers for inclusion/exclusion in a network or make predictions about how a decision point might affect a key performance indicator for that network. For pre-existing networks, identify high or low performers for special contracting arrangements, incentive programs or for replacement opportunities.
For Health Systems: Manage and maintain cost and outcome standards by acquiring high-scoring providers and incenting behavior change in low-scoring providers. Understand the net effect of specialists on your ability to reach cost and outcomes goals. Use the Specialist cost or outcome rating as a weighting measure, along with network volume, to stratify the gain-sharing across a Specialist network.
For Physicians: Get a full picture of your patients after they leave your office. Audit and understand your own performance against your peers and take action on efficiency or quality deficiencies. With future iterations, you will be able to drill-down and understand Care Models you can institute to improve your index scores.
How to Access the CareJourney Index
The CareJourney Index is available to all current CareJourney customers today. Meet with our experts and learn how the CareJourney Index can help you by requesting a discovery meeting here.
CareJourney is a leading provider of clinically-relevant analytics for value-based networks. Headquartered in Arlington, VA, CareJourney currently supports leading payer, provider, and life sciences organizations across the US in achieving their goals by wringing new, high value insights out of expansive population claims data. Through its CareJourney Platform, CareJourney provides members with interactive dashboards of clinically-relevant insights around network design and management, care model management, patient risk segmentation, spend and utilization trends, network integrity, low-value care, and provider, practice and facility (acute and post-acute) performance. Please visit us at www.carejourney.com as well as on LinkedIn, Twitter, and Facebook.
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