2021 Best In KLAS Value-Based Care Managed Services

Competitive and financial factors continue to drive organizations toward value-based care. A widely varied array of services firms and other vendors offer services and solutions designed to help. This report details CareAllies’ value-based care managed services offering and examines client experiences.

Inpatient treatment for high-risk cardiovascular patients comes with a significant cost for patients, providers, and payers. Costs are lower and outcomes are better when the care for these patients is effectively managed outside the hospital. To achieve this, the collaborators in this case study combined payer and provider data to better predict costs and patient outcomes and then established a bundled payment contract that reduces the costs of caring for patients with high-risk cardiovascular diseases while ensuring they receive the care appropriate for their condition. Outcomes include reduced hospitalization and lower costs.

The collaborators in this case study noted that some patient populations were completing preventive annual health assessments at lower levels than other populations. To address this disparity and help clinics close care gaps at the point of care, the collaborators implemented a program aimed at incentivizing frontline staff and physicians on a monthly basis for time spent addressing open care gaps. As a result of the program, the participants have seen improved gap closure, improved performance in quality measures, improved coding accuracy, and higher staff morale and engagement.

Point of Light

Points of Light 2023 Case Study 17

14 April 23 | Aurene Wilford and Boyd Stewart

Vulnerable and underserved populations face a variety of barriers that can make it difficult for them to adhere to their prescribed medication regimens, and the impacts of non-adherence—in terms of health outcomes and costs—can be severe. Low medication adherence was a particular problem for the healthcare organization in this case study, whose patient population covers one of the most vulnerable and underserved zip codes in the country. To encourage better adherence among high-risk individuals, this organization collaborated with a payer organization and value-based care partner to identify patients in need of additional support and help resolve their barriers to adherence. Results include better health outcomes and higher CMS Star ratings.

	Overall performance score (100-point scale)	Trend (2020-2021)	Total evaluations	Loyalty	Operations	Relationship	Services	Value

Guidehealth Arcadia.io	91.9	0%	n=13	A	B+	A	B+	A-

Conifer Health Solutions	86.9	0%	n=7	A	B	B+	B-	B

Lumeris	73.5	0%	n=20	C	D+	B-	C	D+

Evolent Health	59.5	0%	n=12	D-	D-	D-	D+	F
	50.0	100.0

	Overall Performance Score (100-point scale)	Total evaluations	Loyalty	Operations	Relationship	Services	Value

Caravan Health	81.7	n=42	B	B	B	B	C

Elligint Health HealthEC C	92.4	n=12	A	A-	A	A	A-

Health Catalyst	86.7	n=8	B+	B+	A	B+	C+

Lightbeam C	92.1	n=9	A	B	A-	B+	A-

Premier Inc Premier L C	96.1	n=4	A+	A+	A-	A	A+

Value-Based Care Managed Services

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