Outcomes and insights products for payers

The continued rise in healthcare costs has prompted employers and plan sponsors to innovate and explore ways to align more closely with providers of care and the patient.

PotentiaMED’s products assist payers to deploy a reliable, accurate, scalable, and integrated analytics platform to transform ‘silos of intelligences’ into personalized and predictive analytics solutions. We provide high-tech and high-touch applications that connect with the user to help navigate through complex decisions and collect information to support learning systems.

We Assist Payers:

Capture, Integrate Data to Enhance the Evidence

  • Access clinically rich and deep real-world outcomes data from a multi-institutional research base
  • Proprietary access to individual-level, real-world evidence (RWE)
  • Unique longitudinal patient reported outcomes tools (PRO) and data capture, including functioning and quality of life
  • Agreements to gather and incorporate continuous data from multiple providers
  • Large enough samples to uncover personalized and predictive insights
  • Solutions that analyze clinical data registry, claims and socioeconomic data

Employing Data Science to Uncover Insights

  • Personalized and predictive insights, derived from externally-validated, proprietary economic platforms
  • Comparative effectiveness research (CER)
  • Risk-adjusted outcomes and costs by procedure, provider, performance transparency
  • Member population analysis, market identification
  • Identify cost for care across the continuum and its drivers
  • Network assessment, identify high value providers and systems
  • Better understanding of cost, lessen waste or inappropriate utilization, compare local and national outcomes

Outcomes Measures, Incentive Design, Reporting

  • Next generation outcomes metrics, disease management
  • Health risk stratification
  • Risk-adjusted outcomes information for Comparative Effectiveness & QA/QI Quality Improvement (QI)
  • Support value-based care, at-risk contract metrics determination
  • Outcomes-based compensation, incentives tied to individual outcomes not limited to compliance/adherence
  • Longitudinal outcomes tracking
  • Precision performance metrics, survival, clinical response, events of interest, resource utilization
  • Nuanced, risk-stratified outcomes reporting
  • Outcomes reported by an independent party with requisite clinical expertise and genuine objectivity
  • Outcomes-based reporting, adjudication, compensation

Cultivation of Learning Systems

  • Uncover personalized insights, Identification of various sub-populations with different needs
  • Predict high risk patients and avoid high cost events
  • Support informed, shared-decision making, personalized treatment, improved adherence, outcomes
  • Tools and platforms that enable collaboration across providers, patients and payers
  • Reduce procedures, claims paid, complications, improved management of end of life care
  • Increase patient and provider satisfaction
  • Benchmarking, risk adjusted clinical & economic outcomes, volumes and other key metrics

Support of Healthcare Reform

  • Healthcare reform, innovation including outcomes and price transparency
  • Meet Value Based Care (VBC) requirements
  • Merit-based Incentive Payment System (MIPS), Measure Development Plan (MDP), Advanced Alternative Payment Models (APMs)
  • Bundled payment management
  • Coordination of information across boundaries to share care, accountability & risk