Using Real-Time Patient Tracking to Understand Financial Performance in a Bundled Payment Program

Active patient tracking is critical to delivering improved patient care during a bundled payment episode. Importantly, active patient tracking allows providers to understand the current performance of the entire care management program. Changes in utilization provide a strong feedback loop that enables programs to stick with what is working and reject or replace components that do not drive value. Utilization only tells half the story about the performance of a program. Archway completes the picture by providing cost estimates based on past claims history. Through detailed analysis of cost and average utilization patterns, Archway provides real-time estimates of our clients’ performance. Our integrated total cost prediction model uses all available information to accurately predict the cost of an episode from initiation through reconciliation. We combine patient factors, episode type, the patient’s care plan, active patient tracking information, and early claims to produce the best estimate of final costs at each point along the episode’s life cycle.

During the early weeks of an episode of care the care plan provides the most useful source of information for estimating the incurred cost of a bundle. At Archway, our care plans are a roadmap for the patient’s journey through the healthcare event including details on the surgery[1], post-acute care, and the rehabilitation plan.

As the episode progresses, Archway’s patient tracking app provides information about the patient’s progress through the care plan. We use admission and discharge information, as well as updates about ER visits or readmissions to estimate the current cost of the episode. Historical claims performance provides accurate estimates of the cost of these key services.

After the episode has closed and initial claims begin to become accessible we use a combination of patient tracking information and claims to predict the actual cost of an episode. As time passes more tracking information is confirmed and replaced by claims[2] and the final cost of the episode solidifies. This process allows the program manager to view a consistent and stable view of program impact over the course of the program. Real-time data enables quick course correction and significant program impact. The figure below depicts our process of predicting cost over time.

realtime_prog_tracking

Improved delivery of healthcare requires both value-based payment programs and timely feedback. Active patient tracking combined with exceptional predictive modeling enables both real-time learning and real-time program changes to facilitate improvement.

Related Articles:

Medical Claims Lag and Bundled Payments

Tracking Patients Over Time in Value-Based Payment Models

[1] For surgical bundles.

[2] At first including Incurred but Not Reported inflation factors.