CareJourney VBC Navigator

Users can effectively evaluate the VBC landscape with analytics centered on VBC drivers of success to navigate markets you operate in, as well as those you don’t, with informed decisions. This offering drills into our point of view on what constitutes "VBC drivers of success” (maximizing attribution, capturing risk, optimizing specialty spend, etc.) and helps you build a data-driven strategy around each of them.

There are a few key components needed to properly evaluate a risk entity: beneficiary-level claims data, accurate attribution, and accurate benchmark methodology. With data access to 100% of Medicare beneficiaries, their longitudinal claims data, and beneficiary to entity rosters, we are able to accurately measure entity performance across a wide range of measures - financial, quality, care coordination, specialty-specific, and more.

Data sources:

• CMS Medicare fee-for-service claims details
• MSSP Beneficiary and Provider Rosters
• ACO REACH Beneficiary and Provider Rosters Each view (by year) is organized by:
• ACO
• ACO x County
• TIN
• TIN x County
• NPI
• NPI x County The following views are available as part of this listing:
• VBC Population Distribution
• APM Performance: Entities (ACOs)
• APM Performance: Practice Groups
• APM Performance: Physicians (NPIs)
• APM Performance: Geography (County)
• VBC Entity Compare
• VBC Entity Specialty Compare

Sample fields include:

• Demographic Metrics
• Entity ID
• Entity Name
• Entity Geography (County)
• Parent Organization
• APM Type (MSSP, REACH)
• Spend and Utilization Metrics
• Historical Benchmark
• Total PMPY
• Inpatient PMPY
• Outpatient PMPY
• Part B PMPY
• IP per 1k
• Avoidable ED
• Patient Growth/Churn Metrics
• AWV Compliance Rate
• Flu Shot Compliance Rate
• TCM Compliance Rate
• Quality/Care Coordination Metrics
• Lost Patient Count
• MA Switch Lost Patient Percent
• Reassigned Lost Patient Percent
• New Patient Count
• New Patient Visit Count
• Patient Growth Percent
• Specialty Metrics
• Cancer Surgery Patient and Claim Count
• Chemo or Immunotherapy Patient and Claim Count
• Radiation Admin Patient and Claim Count
• Dialysis Patient and Claim Count
• Kidney Transplant Patient and Claim Count
• BH Related Medication Usage Patient and Claim Count
• Psychotherapy Patient and Claim Count
• BH ED Visit Patient Count
• BH ED Visit 7 Day Follow Up Patient Count
• BH ED Visit 30 Day Follow Up Patient Count