Data Platform Supports Acquisition of Practices and Network Growth, Increasing Revenue

THE CHALLENGE

Carle Health planned to acquire numerous practices, expanding the organization, and creating a more robust clinically integrated network (CIN). However, the organization needed to meet critical regulatory requirements. It lacked technologies and processes for reporting pre-adjudicated claims for the practices in aggregate. Inability to report pre-adjudicated claims jeopardized Carle’s ability to acquire the practices. It also prevented Carle from obtaining single signature contract rates for all clinics participating in the CIN.

THE PROJECT

Carle leveraged the Health Catalyst® Data Operating System (DOS™) platform and Leading Wisely, a healthcare decision support solution, to share pre-adjudicated claims and visualize the performance of critical measures across the entire CIN. As a result, Carle can quickly visualize claims and encounter data by various payer groups, including payer, service site, provider group, primary diagnosis, primary procedure, and clinical program hierarchy.

THE RESULT

Carle has a single source of truth for its claims data and robust reporting of pre-adjudicated claims. In addition, the organization met federal reporting requirements, has new insights regarding payer mix trends, can quickly and efficiently visualize utilization trends, and can improve contracting processes and rates.

• Visualization of pre-adjudicated claims data for more than 35 different practices and 150 providers—clearing the path for these practices and providers to join Carle’s CIN. $100K in manual labor costs avoided.
• Regulatory reporting compliance achieved.

“DOS and Leading Wisely provides us with one source of truth and eliminates thousands of hours of burdensome manual data entry and analysis.”

Jennifer Drury, MBA, Director, Carle Health Physician Partners

ADDITIONAL READING

• How Regulatory Compliance Supports Optimal Patient Care and Higher Earnings
• Analytics Enables Identification of Opportunities to Improve Value and Accountable Care Organization Performance
• Using Data-Driven Insights to Improve Practice Management
• Analytics Enables Robust COVID-19 Patient and Staff Contact Tracing
• COVID-19 Capacity Planning Tool Provides Advanced Analytics and Improved Operational Effectiveness