Revealing the Secrets of Provider Network Optimization to Save You Millions

Summary

In this presentation, Keith Summers from Healthcore discusses the critical need for optimizing provider networks to reduce low-value healthcare spending in the U.S., which exceeds $1 trillion annually. By leveraging AI-driven analytics, Healthcore identifies patterns of unnecessary care and provides actionable insights to healthcare organizations. The platform allows for comprehensive evaluations of provider performance, ultimately aiming to improve patient outcomes and reduce costs. Healthcore invites organizations to experience a free sample evaluation, highlighting their commitment to enhancing risk management strategies in an evolving healthcare landscape.

Takeaways

• 😀 Healthcore focuses on optimizing provider networks to improve healthcare outcomes.
• 📈 The company was founded in 2016 with the mission to reduce low-value healthcare spending exceeding $1 trillion annually in the U.S.
• 💡 Optimizing provider networks can potentially reduce healthcare spending by up to 30%.
• 🔍 The process involves analyzing de-identified claims and benchmarking provider performance using proprietary algorithms.
• 👥 Collaboration between providers and payers is essential for effective network optimization.
• 📊 Healthcore's platform provides risk benchmarks to help healthcare organizations identify low-value care.
• 🏥 Many healthcare organizations are unprepared for the shift from fee-for-service to value-based care.
• ⚖️ The evaluation process includes assessing cost efficiency and patterns of care among providers.
• 🚨 Low-value care is defined as care that is clinically appropriate but unnecessary and can be financially burdensome.
• 🎁 Healthcore offers a free sample evaluation for organizations interested in improving their risk management strategies.

Q & A

What is the primary mission of HealthCore?

HealthCore's mission is to eliminate low-value healthcare spending, which currently exceeds one trillion dollars annually in the U.S.

What challenges do healthcare organizations face today?

Healthcare organizations struggle with rising costs, the complexity of the regulatory environment, and the need to shift from fee-for-service to value-based care.

How does HealthCore's platform optimize provider networks?

HealthCore's platform analyzes de-identified claims data using proprietary algorithms to identify and quantify low-value care, enabling organizations to optimize their provider networks effectively.

What is meant by 'low-value care'?

Low-value care refers to healthcare services that may be clinically appropriate but are unnecessary and provide little to no benefit to the patient, often carrying additional risks.

How can HealthCore help organizations save costs?

By optimizing network performance and reducing low-value care, organizations can potentially reduce spending by up to 30%, leading to significant cost savings.

What are some specific features of the HealthCore platform?

The HealthCore platform includes modules for analyzing provider performance, benchmarking against peers, and providing insights into cost efficiency and quality of care.

How does HealthCore validate its recommendations?

HealthCore employs a clinical team to apply an extra layer of validation to ensure that all optimization recommendations are accurate and feasible before delivering a formal report to clients.

What kind of data does HealthCore utilize for its analysis?

HealthCore processes a large amount of both public and private data, including de-identified claims data from over 1 million providers nationwide.

Can clients access HealthCore's analytics on-demand?

Yes, clients can access HealthCore analytics at any time through the HealthCore Now platform, allowing them to perform comprehensive evaluations based on geographic regions.

What is the offer made to potential clients at the end of the presentation?

HealthCore offers potential clients a free sample evaluation if they submit 10 MPI numbers, allowing them to experience the advantages of the platform firsthand.