Population Value™ | Financial Solutions

SPH’s Population Value™ | Financial Risk Analytics powered by Milliman tools uses claims data to monitor expenditure trends, understand leakage, predict future utilization and stratify the population. Both cost and clinical data are used to segment the population into chronic condition groups, high risk and high cost segments.

Population Value supports improvement in the MIPS Cost category. The MIPS Cost category includes two metrics: Medicare Spending Per Beneficiary (MSPB) and Total Per Capita Costs (TPCC). Reducing Medicare costs can be addressed in multiple ways including preventing avoidable hospital admissions and ER visits, reducing readmissions and managing disease complications. SPH’s Patient Outreach Services use multiple modalities (phone, email, mail) to engage patients for cost management programs, such as discharge planning and patient education.

Cost Management

The Population Value application analyzes and categorizes claims data to monitor per member per month (PMPM) expenditures to support cost management for ACO populations. The tool identifies in- and out-of-network expenditures (leakage), as well as identifies trends in expenditure categories, such as inpatient, physician, DME, imaging, etc. Drill down capabilities at the practice, provider and patient level enable focused efforts on cost drivers and overall PMPM performance. The solution leverages claims data so ACOs can improve their financial performance against benchmark goals and targets.

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Population Value Summary screen
Population Value Utilization portion of summary screen

Utilization Metrics

In addition to expenditure monitoring, the Population Value application calculates and displays key utilization metrics that drive overall cost of care. Executive level and drill down review of critical utilization metrics (e.g. admits per 1000, ER visits per 1000, average LOS and readmission rates) are important for monitoring financial health. Identifying emerging trends in the data enable proactive steps to mitigate waste and unnecessary utilization.

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Financial Risk

Proper management of health care costs requires a deeper understanding of population risk and the ability to identify those with high risk or rising risk of higher utilization. SPH’s Population Value application uses the industry standard Milliman Advanced Risk Adjusters (MARA) models to calculate an individual risk score to predict future spending and utilization. The MARA model can break down the risk based on service categories (inpatient, outpatient, pharmacy, etc.) as well as identify which clinical conditions are driving the most risk. The application can identify high risk patients for interventions and proactive care as well as predict which patients are most likely to have a hospital admission or ER visit in the subsequent 12 months.

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Population Value Risk Stratification screen

Partner with a Trusted Leader

SPH Analytics has more than 25 years of experience driving quality program success. We have the experience and expertise clients trust to improve clinical care, enhance patient experience, and reduce costs to meet the Triple Aim.