CareJourney: APM Financial Benchmarking

CareJourney’s APM Financial Benchmarking data asset is a comprehensive, value based care resource that enabled VBCs to calculate their financial benchmarks across APMs

VBOs have generally operated with insufficient data before opting to enter into a VBC arrangement. Critical decisions regarding program entry, network formation, and stop-loss insurance have been made using incomplete, scattered, un-actionable datasets, resulting in some organizations experiencing sufficient losses.

With data on over 60M+ Medicare beneficiaries, CareJourney’s data asset enables VBOs understanding of which groups are caring for your providers and where your providers have relationships. CareJourney’s data asset sheds light on these questions and more with 2M+ NPI utilization and leakage patterns profiled.

Data sources:
- CMS Medicare fee-for-service claims details
- CMS Physician Compare
- NPPES data

Each view (by year) is organized by:
- Provider x Group x Geo x Cohort
- Provider x TIN x Geo x Cohort

Sample fields include:
Demographic Metrics
- Provider ID (NPI)
- Provider Name
- Hashed TIN
- TIN Name
- Facility ID (CCN)
- Cohort
- Year
- Alignment Period
- Geographic Details

Premium Metrics
- Risk Score
- Count of Patients
- Count of High Needs Patients
- Total Member Months
- Total Spend
- Spend Breakouts
- Utilization per 1K

搜集汇总

背景与挑战

背景概述

CareJourney的APM财务基准数据集是一个综合性价值导向医疗资源，旨在帮助VBC计算财务基准。该数据集基于超过6000万医疗保险受益人的信息，提供了200多万NPI利用和泄漏模式的分析，数据来源包括CMS医疗保险费用索赔和NPPES。