Advanced Analytics Are Driving the Value-Based Care Transformation Without a doubt, the healthcare industry is in the midst of a major transformation to value-based care. Nearly all health plans report having some type of value-based arrangements in place, and a 2017 Chilmark Research report found the number of accountable care organizations (ACOs) has grown 13-15 percent in each of the last two years and there are now more than 935 ACOs covering approximately 10 percent of Americans.

Early results indicate value-based care is working as intended to improve the quality and costs of healthcare. Some of the many examples are:

• Blue Cross Blue Shield of Illinois participates in 20 value-based arrangements that serve one in four of its members. The company reports emergency visits are down by 16 percent, hospital admissions have decreased 15 percent, and spending has declined by $17 per member per month.
• Harrisburg-based Capital BlueCross created its first value-based care contract in 2011, and now more than 2,800 physicians and 362,000 customers participate. Earlier this year, the company published results showing these value-based partnerships outperformed their fee-for-service peers in 19 of 25 tracked Healthcare Effectiveness Data and Information Set (HEDIS®) measures such as breast, cervical and colorectal cancer screenings and reduced emergency visits and hospitalizations.
• Anthem reports a 7.8 percent reduction in acute patient admissions, a 9.6 percent improvement on pediatric preventive care, and a monthly savings of $9.51 per participating patient.
• UnitedHealthcare reports patients have 8 percent fewer emergency department visits and as many as 16 percent fewer hospital admissions. Breast cancer screenings are up 11.4 percent for commercial ACO members and colorectal screenings are up 7.8 percent for Medicare ACO members. These results might suggest the healthcare’s transformation to value-based care is easy. It is not.

At the heart of these success stories are advanced analytics platforms that integrate claims, clinical, lab, pharmacy and wearables data and apply predictive and prescriptive analytics to create one comprehensive profile of each patient, a profile that includes current health status and predicted health needs, and is shared by the health plan and participating providers to improve care coordination and outcomes. In this session, Caron will discuss real-world examples of how health plans, physicians and others in the healthcare industry are using advanced analytics to drive value-based care success.