CapsicoHealth Simplifies The Transition To Value Based Care

CMS and Commercial payors are aiming to transition over 50% of beneficiaries to value based payments by 2020. This is a complex undertaking for providers, ACOs and payors as it requires significant transformational change in provider culture, medical decision making and operational processes to take on upside and downside risk. CapsicoHealth addresses these challenges through proven methods and technology.

How Does CapsicoHealth Drive This And Enable Value?

CapsicoHealth powers a state-of-the-art, AI driven platform to seek out margin opportunities and reduce operational costs (FTE savings per year) through automated data integration, flexible risk contracts, utilization risk, and insights for improving patient outcomes.

CapsicoHealth's automated data platform and AI tools (with forecasting, what-if-models, predictive analytics and NLP) unlock key insights from hundreds of millions of claims, social, cost and EMR data, and enable providers to create new risk sharing models and manage complex a range of CMS and commercial contracts (e.g. CJR, BPCI, Capitated models and OCM) with minimal transactional costs. Our solutions drive 99% accuracy in data quality, 15% reduction in operational costs, over 80% accuracy in identifying negative outcomes (e.g. hospitalizations), and 90% savings on manual steps needed to generate insights.

AI Driven Analytics for Outliers

Providers are challenged with analyzing billions of data points across diverse sources (internal and external) to identify high risk outlier populations, and enable timely care of patients. Manual processes and limited resources will add to the cost and reduce scope. Providers can leverage Capsico's AI driven analytics with minimal manual processes to identify outliers and margin areas, and reduce operational costs.

Provider Networks Optimize Care

Poor outcomes occur when patients transition between uncoordinated providers. Studies have shown a rise in unplanned admissions and cost variability (e.g. unnecessary tests) due to lack of coordination. With a shift towards value based payment, there is a strong incentive for anchor providers to collaborate with high performing networks of providers (e.g. post-acute and PCPs)

Insights Help Target Opportunities

Providers and ACOs are challenged with collecting vast amounts of data to generate insight to reduce costs while keeping quality of care at an optimal level. The challenges are compounded as data from claims, EMRs, billing and HR need to be analyzed continuously in real-time for cost reduction opportunities, steerage and quality improvement

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