UpStream Tracks Real-Time Provider Cost and Utilization Trends with Weekly Insights
UpStream is a primary care solution provider that supports PCPs with necessary resources by embedding highly specialized care teams, including pharmacists, into each doctor’s office, and having a set of virtual concierge and other non-licensed staff supporting patient care.
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Challenges
UpStream wanted to track cost and utilization metrics for ACO REACH participants with the most timely analytics possible. They sought analytics that were more timely than monthly Claim and Claim Line Feeds in order to more accurately understand cost and utilization trends, support patients as quickly as possible, and align on physician payments.
How CareJourney Helped
Upstream worked with CareJourney to enrich weekly adjudicated Beneficiary Claims Data API files with relevant analytics for prioritization and intervention pulled directly from the CareJourney platform. This gave Upstream the ability to benchmark a provider’s spend, volume, and quality of care in a more timely fashion—weeks sooner than their team was able to do with CCLF data.
CareJourney’s BCDA analytics also gave UpStream the ability to track their avoidable ED admissions as well as inpatient admits. This gave their care teams a detailed look at the rates of patients who presented to the emergency room or were admitted with a diagnosis that could have been treated at a lower level of care. Expedited insights from CareJourney allowed UpStream to quickly identify improvement opportunities, intervene more proactively, and follow up with patients in a more timely manner.
Lastly, UpStream utilized the CMS benchmarking report, CMS risk report, and beneficiary alignment report combined with the BCDA claims data to track and forecast Hierarchical Condition Category scores. This is important because the HCC risk score dictates the reimbursement rates for claims submitted in the following year, and UpStream could prepare accordingly for the estimated reimbursements.
Impact
UpStream leveraged CareJourney’s BCDA analytics to create a weekly version of CMS’ Monthly Expenditure Report. This allowed UpStream to prepare for increases in medical expenses before they receive CMS’ monthly or quarterly reporting. This also enabled UpStream’s finance team to close out monthly financial reporting without waiting for monthly claims data being refreshed and processed.
1,000+
Participating PCPs
“The CareJourney BCDA analytics feed allows us to get more timely information and actionable insights that help reduce care gaps and manage our expenditures better.
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John Supra |