Risk Adjustment

Value Based Analytics

Clearinghouse + EDI

Track utilization and costs associated with the delivery of value-based contracts.

Reduce Costs and Avoid Inappropriate Utilization and Waste While Improving Quality of Care

Today’s healthcare providers are under significant pressure to control costs for their patients. Veradigm Value-Based Analytics (formerly Evalu8) delivers the real-time visibility needed to monitor and manage Key Performance Indicators that track utilization and costs associated with the delivery of your value-based contracts. With Veradigm Value-Based Analytics, accurate action can be taken to achieve improved and equitable health outcomes, resulting in overall lower total cost of care. Veradigm Value-Based Analytics supplies value-based contracts/programs and providers with the analytics and insights needed to identify targets for improvement. It empowers clients to take actions that can lead both to better healthcare and to improved financial outcomes.

Optimize Your Value-Based Contracts and Programs By:

  • Reducing inappropriate Emergency Department utilization
  • Improving 30-day unplanned readmission rates
  • Decreasing cost-of-care
  • Identifying Social Determinant of Health (SDOH) risks
  • Minimizing revenue leakage due to services referred out-of-network
  • Accessing program performance analytics at a single location

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Track Utilization and Costs Associated with the Delivery of Your Value-Based Contracts

Veradigm Value-Based Analytics delivers visibility to help monitor and manage Key Performance Indicators (KPIs) that track utilization and costs associated with the delivery of your value-based contracts. Value-based programs all depend on transparency into the most accurate benchmarks based on health condition risk stratification for predicting success.

Tracking utilization (emergency department, inpatient, and readmissions) and minimizing revenue leakage due to services occurring out of network is vital to high-performing value-based programs. Providing visibility into the types of services occurring out of the value-based agreement also assists in better contract and network design in the future.

Veradigm Value-Based Analytics dashboards provide a spatial representation of where out-of-contract and out-of-network services are occurring, along with the associated specialties and locations. These details can be used to fill holes in your specialty provider network and/or geographic coverage to reduce leakage.

Veradigm Value-Based Analytics stratify patients by SDOH community-level and risks. Payers and providers can use this SDOH stratification to examine differences in utilization and costs. These details can be used to prioritize individual level screening for SDOH risk factors and plan community and individual level SDOH interventions.

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Supporting Clients to Decrease their Downside Risk and Maximize their Shared Savings

Get a more complete view of patient care and morbidity, including health care condition risk stratification and SDOH community risk factors. Whether you are a health plan executive helping your key network providers generate tangible savings for your plan and themselves, or an Accountable Care Organization administrator tracking the performance drivers within an array of value-based agreements across your many payers, Veradigm Value-Based Analytics can help deliver value.

Combining an analytic framework that has made Veradigm renowned within Risk Adjustment1 with its benchmark data and geospatial analysis, Veradigm’s solutions delivers essential support for managing “network leakage and keepage,” utilization and cost control, and SDOH coding.

Reducing Administrative Waste, Financial Accuracy, Being a Single Source of Truth To Empower High-Value Partnerships

  • Track PMPM performance to benchmarks
  • Network Leakage analytics by claim type, specialty, and facility
  • Gain visibility into out-of-network referrals by PCP or Provider Group

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  1. Pulse8. Analytic Logic: Risk Adjustment Analytics, Financial Reporting, and Risk Mitigation V18.11.0. Accessed March 25, 2021.

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