New York City IPA: Moving to Value Based Care

Value based care is complex process. A true care model requires collaboration from every participating entity. Equipo integrates the whole care delivery system to help achieve value-based care model. New York City IPA practice leaders realized payment reform was a reality; they needed transformation into a new model of care.

Challenges

• Several providers with disparate EMRs. Missing unified repository for a unified view.
• Organization lacked real time access to patient data through participating providers.
• Providers had no easy way to find out their performance and to act on gaps in care.
• Data unavailable from external entities like Hospitals, MCOs, Community Labs and pharmacies. Providers unaware of hospitalizations or ED visits.
• MCOs needed visibility on real-time progress and manage outliers for improved care.

Solution: A comprehensive integrated solution that compiles all data in real time, analyzes the data and provides actionable insights for continuous improvement.

Equipo Story

• Integrates data from individual providers in near real-time.
• Integrates data from MCOs (Roster, Medication Adherence, Care Gap, High Flyer list).
• Integrates Transition care data in real-time.
• Integrates Medication data in real-time.
• Integrates Eligibility data in real-time.

Once all the data elements are compiled, Equipo runs its quality analysis for finding out gaps in care, risk gaps, gaps in medication adherence, gaps in transition care. Data is presented as a task list for the care team to act on.

• Filter to identify most critical patients
• Identify and act on most impactful cases
• Generate real-time monitoring alerts
• Task management for care managers
• Automate reminders and follow ups

Outcome

• 22% increase in reduction of Care Gaps
• 28% increase in Roster Enrollment
• 16% decrease in Inactive patients
• 12% increase in Medication Adherence
• 90% adherence in Transition Care
• 24% overall cost savings