Healthcare Analytics

APM | Alternative Payment Models

As the healthcare industry evolves toward value-based payment, our team uses its experience with past and current Alternative Payment Models (APMs) to help your healthcare organization leverage your data so you can better understand performance drivers and streamline and coordinate care. Our products include solutions focused on:

• Bundle Payment Care Initiative – Advanced (BPCI-A): A Medicare initiative that links payments for multiple services that beneficiaries receive during an episode of care. It aims to produce higher quality, more coordinated healthcare at a lower cost to Medicare by incentivizing hospitals or clinician groups to assume accountability for the total costs of care during a specified “episode.”
• Comprehensive Care for Joint Replacement (CJR): This CMS initiative sought to improve coordination of care for lower extremity joint replacement or reattachment of a lower extremity. Acute care hospitals in certain selected geographic areas received retrospective bundled payments for episodes of care as an incentive to manage total episode spending—not just inpatient costs—through coordination with physicians and post-acute providers.
• Enhancing Oncology Model (EOM): CMS designed EOM to test how to improve your ability to deliver care centered around patients, consider your unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes.
• Kidney Care First (KCF): The Kidney Care First (KCF) models were built upon the existing Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model structure, in which dialysis facilities, nephrologists, and other healthcare providers form ESRD-focused accountable care organizations to manage care for beneficiaries with ESRD.
• Shadow Bundler: Similar to our BPCI-A dashboard, Shadow Bundler is designed to leverage available innovator data to help provide insights on your organization’s performance in key areas, such as beneficiary spend, post-acute network spend, and readmissions. 

ChaRT | Clinical Documentation Improvement Review Tool 

This solution is a bi-directional communication tool for clinical documentation improvement. ChaRT helps you identify charts for review by a Forvis Mazars team. The review captures additional information and potential coding adjustments. Afterwards, notification is sent to you so you can agree or disagree with Forvis Mazars feedback and generate reports based on the review process. ChaRT is available for inpatient DRG and HCC review, as well as outpatient ICD-10 and Procedure code evaluation. 

Denials Management Monitoring

This platform can help your organization identify trends in your denials and resolve issues. It’s not meant to be a task queue but a way to better understand your denied claims and enable informed decisions that can help prevent new denials.

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Employee Benefit Plan 

Many self-insured organizations don’t get the insights needed to understand and manage healthcare expenditures from routine third-party administrator (TPA) reports. Our employee benefit plan solution scans healthcare claims to deliver analytics that measure and monitor your performance based on membership, utilization, spend, and quality.

Exclusion Testing 

Exclusion Testing is a monthly service that can help your organziation stay up on regulatory compliance. Hospital associates, pharmacies, and vendors can be placed on federal and state exclusion lists for a variety of reasons. Exclusion Testing compares your data to publicly available federal and state exclusion lists. Any flagged matches due to address, name, or NPI are manually reviewed by our team using agreed-upon criteria and presented to you as a monthly deliverable. 

Fair Market Value

Fair Market Value assesses how your hospital or hospital network’s physician compensation compares to market value by studying compensation and wRVUs and assigning a score for overall risk. You can review this comparison on an individual basis or by department. Department comparisons provide the departmental national average and your hospital’s average.

Hospital Quality & Efficiency Program (HQEP)

An HQEP is a contractual agreement between a health system and a Clinically Integrated Network or Accountable Care Organization for achieving quality improvements and cost reductions within the inpatient setting and/or employee population. Our analytics measure your performance against agreed-on KPIs.

Post-Acute Network (SNF & HHA) Rating System 

Combining your network of skilled nursing facilities (SNFs), home health agencies (HHAs), and CMS’ SAF quarterly data, this solution generates a state- and network-level benchmark to score and rank each SNF and HHA in various metrics, such as:

• Readmission Rates
• Hospitalization Rates
• Unplanned ED Rates
• MSPB Score
• DRG Weight
• Average Length of Stay
• Improvement in Function Rates
• And More 

Market Snapshot (Demographics Analysis) 

This solution provides in-depth demographic insights on the target market via your organization’s zip code or county-based service area definition. Market Snapshot tracks over 400 benchmarks and attributes on a yearly basis. Main dashboard metrics include zip code, county, state measures for current year and future year (5Yr) populations, CAGR, percentage of families under the poverty line, age group, genders, race/ethnicity, education, household income, as well as healthcare provider overview and locations, etc. 

Medicare Shared Savings Program (MSSP Analytic Suite) 

This solution analyzes detailed and summarized data for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP), providing timely and meaningful information to help improve individual and population health and reduce the cost of care. MSSP Analytic Suite can help your clinics and physician and hospital organizations implement and evaluate new delivery models to better understand their impact on the health, quality, and financial viability of the local community and healthcare delivery system. It utilizes CMS’ quarterly Medicare claims data feed to generate Medicare Spend per Beneficiary Analytics to help improve clinical disease management strategies and network performance.

Revenue Cycle 

This dashboard reveals trends in healthcare financial performance. Select the KPIs most important for you and compare to industry benchmarks. Your organization can analyze trending data over your gross revenue, adjustments, estimated net revenue, accounts receivable, and RVU. 

Service Line Dashboard

Healthcare providers need better information to understand growth opportunities, including service lines and locations. The Service Line Dashboard aggregates state discharge data to help you better understand market share, volume, contribution, service line, and migration. Depending on the state and your organization, patient types can include inpatient, emergency department, ambulatory surgery, or outpatient services. 

Sta²T | Physician Enterprise Analytics

Today’s physician enterprises require access to data to make informed business decisions and implement behavioral change initiatives. Sta²T is a data analytics platform designed to help provide your physician enterprise with actionable insights on current and historical performance for revenue cycle, productivity, and capacity. Sta²T standardizes your EHR and practice management data, using proprietary business logic to create tailored visualizations. This tech enabler helps keep you ahead of the curve with transparent, reliable data.

Total Per Capita Cost

Total Per Capita Cost (TPCC) is an essential solution for measuring Medicare spending. This solution focuses on the importance of payment models for primary care management. Effective primary care management can support healthcare spend savings in several ways, including improvements in chronic condition treatment by reducing the need for high-cost hospital or emergency department services. More effective primary care management also can help direct a greater proportion of patients to lower hospital costs for inpatient services. Given the potential for decreasing spending through primary care delivery improvements, TPCC helps your organization identify savings opportunities by capturing broader healthcare costs influenced by primary care. 

Workforce Productivity Manager

This solution enables your organization to monitor areas within your institution to help create a more productive management culture. Identify potential financial opportunities at the department level by assessing measures, such as staffing variances and the quantity of labor being used to deliver a unit of workload. 

Denials Management Monitoring

This solution can help your organization identify trends in your denials and resolve issues. It’s not meant to be a task queue but a way to better understand your denied claims and enable informed decisions that can help prevent new denials.

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Post-Acute (Rehabilitation) 

Our rehabilitation analysis of skilled nursing facilities (SNF), home health (HHA), inpatient rehabilitation facilities (IRF), and long-term acute care (LTAC) provides dashboards that compare your organization’s performance with other facilities (admissions, readmissions, ALOS, etc.) and state and national average benchmarks.

Pulse™ | Performance Benchmarking Tool

Pulse^TM for Post-Acute synthesizes Medicare discharge data from inpatient providers to create a national database that helps your SNF or HHA compare your performance against other providers and establish a competitive advantage in your market. The national database leverages three years of data to analyze market share and KPIs, readmission rates by service line and DRG groupings, inpatient provider and physician referrals, quality measures, and a service line analysis. 

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