With the move towards Medicare and commercial payor based risk and profit sharing models, acute and post-acute providers have strong incentives to spot opportunities to reduce variations in costs and identify quality improvements.
CapsicoHealth enables deep insights for financial specialists at providers, ACOs and Payors by analyzing billions of data points around population level costs, utilization and quality to reduce variation while improving quality of healthcare services to patients. CapsicoHealth drives this through advanced technology that can analyze thousands of rules in real-time across vast data sets, and spot cohorts with high cost variations. CapsicoHealth's guideline driven analytics tools enable anchor (or lead) providers to derive better insights from episodes and optimize pathways for patient recovery within a cost boundary.
For providers to embrace value based care and payments they have to identify areas where total cost of care can be reduced across sub-populations.
In addition, providers have to minimize the negative outcomes over sub-populations (e.g. hip/knee patients with complications and unplanned readmissions). Poor or limited coordination amongst providers
with no sharing of critical patient health status information can lead to patient hospitalizations, unplanned ER visits
and non-adherence to care pathways.
CapsicoHealth's AI driven platform provides tools for providers to manage risk contracts, identify opportunities to reduce cost variation (e.g. high and knee surgeries), and improve care in a timely fashion. Studies have shown that 35% of patients do not adhere or follow their treatment plans and health goals. CapsicoHealth's platform can pin point high risk outlier groups that are likely to have unplanned hospitalizations or ER visits, and lead to rising costs for at-risk patients.