Accountable Care Organization & Collaborative Care Integration
Building excellent ACO services requires a deep understanding of claims processing and the algorithms that drive those processes. Byte Sized Solutions has the unique expertise in ACO data flow required to design and build effective connections between ACOs, Medicare and other payers.
Simply put, we bring efficiency in systems integration, meaning less waste and real savings for your organization. If you’re just starting out, we can partner with you to design your system and set up your ACO. If you’re already up and running, we’ll take a macro view of your data management architecture and help find efficiencies or enhancements. No matter the stage of deployment you’re in, we can help.
ACO/Healthcare Business Expertise (i.e. what we do)
- Build out and parsing EDI
- Medical and pharmacy claims metrics, reporting and analysis (e.g. ODAG and Part C reporting to CMS)
- Member eligibility metrics, reporting and analysis
- Member/PCP attribution, using Medical Claims History and Geospatial Mapping
- Distribution and management of claims to staff for processing
- Member Out Of Pocket (MOOP) Processing and Reporting
- Internal controls and error checking for claims processing
- Provider management and reporting
- EDI files / EDI generator – an application to digest 837 & 834 field as well as to parse file and load them into SQL warehouse.
- Adjudicating of split-risk claim processes add more details or split out
- Clinical and Business Process Automation
- File web download and parsing (e.g. from payers)
- File preparation and web submission (e.g. to payers)
- Letter generation and printing
Technology Capabilities (i.e. how we do it)
- Dataflow management and integration
- Data warehouse management
- Database design
- Data visualization and reporting
- Data standardization
- Extract/Transform / Load (ETL)
- Master Data Management (MDM)
- Query Performance Tuning
- Application development
- Web application development
- SFTP automation
- Machine learning
Technology Expertise (i.e. what we use to do it)
- Microsoft SQL Server
- SQL Server Management Studio (SSMS)
- SQL Server Reporting Services (SSRS)
- SQL Server Integration Services (SSIS)
- SQL Server Analysis Services (SSAS)
- Visual Basic
- .NET Framework
Case Study: ACO Integration
“Byte Sized Solutions has the depth and knowledge to handle diverse data sources, file types, and integration types. This allows them to develop efficient tools to drive new processes and payer mandates.”
Director of Information Services – Advocate Health Partners
In partnership with the Center for Medicare and Medicaid Services (CMS). Advocate Physician Partners (APP) saved Medicare, taxpayers and beneficiaries more than $60 million in 2016. Ranking second in savings of 432 ACOs participating in the Medicare Shared Savings Program (MSSP), Advocate was among the highest in quality results while providing care to the largest group of Medicare beneficiaries.
Advocate Physician Partners (APP) saved Medicare, taypayers and beneficiaries more than $60 Million in 2016.
Of participating MSSP ACO’s will recieve a shared saving check. This percentage has remained almost stagnant for the past few years
Some of our Integration Services
ACO Systems set-up & implementation
Dataflow management and integration
Master Data Management
Metrics & Analytics
Data warehouse management
ETL Extract, Transform, Load
IDX – GE Managed Care system
SQL Server Experts
EDI files & EDI generator
Master Data Management
Data management is a weighty responsibility for any healthcare organization. MDM solutions are a lifeline in this sector, allowing segmented enterprises to standardize and pool critical data into a single database, and pull from this common point of reference for reporting and management.
With an MDM solution in place, Accountable Care Organizations, Health Information Exchanges and organizations involved in merger or acquisition processes can accurately consolidate information on patient identities and activities from disparate systems. By channelling cross-organizational data into a master database with integrity assurance, ACOs and HIEs gain more efficient access to reliable business intelligence, allowing for faster reporting and smarter analysis.
Byte Sized Solutions offers
- Access to reliable and comprehensive data, providing a more holistic patient overview
- Reduced time spent on data maintenance
- A bridge from segmented data management to one central, standardized system
- Guided implementation & training – no “good bye and good luck!”
- Data integrity analysis
- A tool designed specifically with ACOs and HIEs in mind
To learn more about our healthcare-centered approach to Master Data Management, check out our MDM whitepaper
Having a single point of reference means there are no conflicting instances of data and no need to figure out which instance is the “source of truth.” There are audit trails so that you can track changes over time if there is a concern about the integrity of a piece of data.
Allows you to track how individual pieces of data get into the master set and trace back any concerns to their original source.
Across all populations at once becomes a simple task when data is stored in a master set. There’s no need to create separate reports with separate logic for different populations—you can report on all of the data in one master report per business need. This makes fair comparisons between populations easy, giving you access to insight you didn’t have before.
Our consultants specialize in identifying cost-saving, user-friendly opportunities that automate manual processes for our healthcare clients. Working with new and mature technologies, the solutions we provide are robust, comprehensive and manageable. Years of experience consistently confirm: fine-tuning business processes with data automation is the best way for an organization to save time and money.
Spotlight On Services
Reliably and easily evaluate paid claims on a periodic basis for potential errors in pricing. Our automated system handles patient outreach, creating a cost-effective way to review overpaid claims and recoup misspent funds. Speaking in numbers, our clients have used 100% Audit to identify more than 13,000 overpaid claims – that’s over $3 million in retrievable funds.
By the numbers
In the past 12 months has identified over 13,000 claims resulting in requests for recovery of over $3 million. Since starting the process in 2010 has requested recovery on more than $14 million in overpaid claims
Match patients to their ideal Primary Care Physician through automated analysis of provider encounter history. With Claims Attribution, ACOs have better visibility into patient care and can better measure PCP performance – resulting in simplified administration and improved patient experience.