Newly Released Government Health Data Key for Doctors, Hospitals Intelligently Moving to Pay for Value and Risk Arrangements

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RowdMap, Inc. talks about Using Government Benchmarks to Intelligently Transition into Risk-sharing Arrangements at CAPGs' National Healthcare Conference, Delivers an Analysis of Risk-Ready Providers

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For the first time ever, these new data releases allow every provider in the nation to understand unnecessary spend and no-value care among their doctors and how that translates into their ability to successfully take on risk.

Joshua Rosenthal, PhD, Chief Scientific Officer and Co-Founder at RowdMap, Inc., will be speaking on how doctors and hospitals can use newly released government data to intelligently transition into risk-sharing arrangements and delivering an analysis of providers and their performance against national and regional benchmarks for unnecessary spend and no value care at the 2015 national conference of CAPG – The Voice of Accountable Physicians Group, June 13th in San Diego, CA.

Newly released government data on physicians, hospitals, and other provider classes has created a sensation on the evening news, but the real opportunity comes when providers use these government benchmarks to inform their strategy to transition from fee-for-service to pay for value arrangements. Using these data to understand which doctors in their network are ready to take on risk will be key as CMS moves away from fee-for-service payments. "For the first time ever, these new data releases allow every provider in the nation to understand unnecessary spend and no-value care among their doctors and how that translates into their ability to successfully take on risk." Joshua Rosenthal, PhD. Chief Scientific Officer, RowdMap, Inc.

Furthermore, these data releases have allowed the creation of a nationwide baseline for benchmarking a doctor’s practice patterns and their likelihood of success with a wide variety of pay for value arrangements across government programs and risk sharing partnerships health plans. RowdMap's Risk-Readiness Benchmarks help to identify high quality, high efficiency delivery of care as health plans and providers develop more advanced and innovate risk-sharing arrangements.

The newly released government data proves exceptionally powerful in building relationships between providers and health plans to improve member experience and delivery of care. By identifying areas of unwarranted variation, providers can identify potential areas of risk and exposure in value-based arrangements. Using these public data has been shown to outperform standard risk stratification techniques and provide visibility into the practice of care that is typically not reflected in actuarial analysis of unit cost or utilization reviews.

Providers use these benchmarks in discussion with health plans as well as inputs to more advance risk-sharing and pay-for-performance contracting arrangements. Providers should become well-versed in using these data sets in health plan conversations, since the increasing volumes of government data released will become an essential input into running any provider system or health plan over the next few years.

Understanding this data will be essential to participate in a pay-for-value world —especially in California where risk and performance arrangements are the norm, and network adequacy needs to be aligned with network quality. The new benchmarks are essential to understanding where natural high and low value referral pathways exist, and how aggregate practice patterns and geographic population characteristics influence the overall performance of a network. These insights make network configuration a key strategic differentiator and determine an organization's ability to succeed in risk arrangements.

Rosenthal will be delivering preliminary results of an analysis using public data on different provider groups including CAPG members. “CAPG members appear to perform higher than national and regional benchmarks, especially when adjusted for risk. On one hand, this may not be surprising, but the degree to and scope with which CAPG members seem minimize unnecessary spend and no-value care is looks to be significant. There are outliers, but on the whole it speaks to an underlying approach to the delivery of care that is both positive and in line with succeeding in pay for value programs but may not be reflected in actuarial, unit cost analysis, or utilization review that tends to reflect the fee for service operations.” Joshua Rosenthal, PhD. Chief Scientific Officer, RowdMap, Inc.

CMS has set the goal to move to pay-for-value, but CAPG is already there. Other provider groups and government agencies will be trying to model the risk arrangements CAPG has been doing for years. CAPG is on the cutting edge of the new pay-for-value incentives and risk bearing arrangements and the newly released government data speak to the degree to which CAPG members are providing high quality care that is particularly applicable to taking on increasing risk.

About RowdMap, Inc:
RowdMap helps health plans, government payers, providers, and hospital systems develop Risk-Readiness strategies to excel as they transition from fee-for-service to pay-for value. As CMS sunsets fee-for-service payments, RowdMap's Risk-Readiness Platform helps payers and providers identify and manage unwarranted and unexpected variation. RowdMap identifies ideal provider arrangements based provider practice patterns and population characteristics within a geography. Payers and providers then use RowdMap to build strategies around these new risk relationships. RowdMap helps them enter new markets, segment populations, identify waste, design products, and understand referral patterns. RowdMap's platform comes preloaded with government benchmarks out of the box—no IT integration required. RowdMap's Risk-Readiness Platform works across all market segments and has significantly larger returns than traditional medical economics approaches. Ernst & Young (EY) has announced Melanie Rosenthal, Co-Founder & CEO, Joshua Rosenthal, PhD, Co-Founder & CSO, and Burak Sezen, Co-Founder & CTO of RowdMap, Inc. as finalists for the EY Entrepreneur Of The Year® 2015 Awards in the Ohio Valley Region.

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