Providers and Medicare Advantage plans: Improve Efficiency with DxCG Intelligence

Less than a quarter of those eligible for Medicare opt to enroll in a Medicare Advantage plan, despite demonstrably better long-term outcomes for members and payers alike. Although some Medicare Advantage programs slightly outstrip the average fee-for-service (FFS) spend, studies show that Medicare Advantage members enjoy shorter hospital stays, better management of chronic conditions and even lower mortality rates—1.8% vs. 6.8% for FFS members studied.

Medicare Advantage plans must adhere to both government regulations and private industry’s demands for maximum efficiency. And while PMPM cost is one hallmark of efficiency, it doesn’t paint the whole picture. One Medicare Advantage program wanted to dig deeper in order to be able to present a better story to potential members—and to build upon the successes of their best-performing providers.

Using Verisk Health's DxCG Intelligence, this Advantage Plan created an Efficiency Index that calculated each provider’s efficiency via a ratio of actual costs to expected cost. The program then compared ratios among all providers in their network. 80% met the plans efficiency goals. With this information, the Medicare Advantage program could target the less efficient 20% and help them control patient costs. As a result, this Plan's average efficiency has improved over three consecutive years.

Having access to highly-detailed data helped this Medicare Advantage plan demonstrate its own value—and allowed its management team to zero-in on areas for provider improvement with the highest impact and greatest chances for success.

You can learn more about Verisk Health’s solutions for Medicare Advantage plans online.