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

When presented with trusted, independent information through care managers, members make more informed treatment decisions resulting in improved outcomes and value-based care decisions while reducing the cost of care. PotentiaMetrics provides high-tech and high-touch applications that support personalized, value-based decisions and support learning systems.

We Assist Payers to:

Capture, Integrate Data to Enhance the Evidence

  • Access clinically rich multi-institutional real-world outcomes data 
  • Unique longitudinal patient-reported outcomes tools (PRO) and data capture, including functioning and quality of life
  • Large enough samples to uncover risk-adjusted insights at the patient level 
  • Solutions that combine and analyze clinical data registry with claims, and other data  

Employ Data Science to Uncover Insights

  • Individualized insights, derived from externally validated data analysis 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
  • A better understanding of cost, lessen waste or inappropriate utilization, compare local and national outcomes

Define Outcomes Measures, Incentive Design, and 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
  • Outcomes-based reporting, adjudication, compensation

Cultivate Learning Systems 

  • Uncover personalized insights, Identification of various subpopulations with different needs
  • Predict high-risk patients and avoid high-cost events
  • Support informed, shared-decision making, personalized treatment, improved adherence, outcomes
  • Reduce unnecessary procedures, paid claims, and 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
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