DEFINE YOUR OWN PATH TO VALUE-BASED CARE

Predictive & prescriptive analytics paired with deep expertise provide insights to better manage risk & revenue, improve quality

and optimize networks.

Healthcare executives predict the value-based care tipping

point to occur near the year 20201. In fact, some of the

industry’s largest health plans (United Healthcare, Aetna

and Anthem) indicate they are paying out almost half of

their reimbursements via value-based care models2 today.

The shift is happening, for some faster than others.

But for all healthcare providers the same

is true: delivering the highest quality

care at the lowest cost is what

success looks like.

SCIO® partners with providers

to deliver insights that keep you

ahead of your performance goals.

Our services and solutions focus

on the most impactful areas of

your business, designed to deliver

the greatest value as you begin

or continue your journey toward

value-based care delivery.

3

SCIO’s approach centers on delivering insights across all lines of business, including Medicare, Medicaid and Commercial populations. These aggregated insights across the population fuel data-driven decisions in key areas that most influence value-based care: improving quality & compliance, optimizing revenue & risk and provider network management.

IMPROVING QUALITY & COMPLIANCE

With the numerous healthcare quality initiatives underway for providers, SCIO understands how challenging and complex it can be to track and manage quality performance.

SCIO works with provider organizations to:

PROACTIVELY AND EFFECTIVELY MANAGE CARE GAPS

• Gain a comprehensive view of where care gaps exist across populations

• Understand care gaps across conditions

• Prioritize care gap closures based on highest opportunity to impact financial outcomes

• Develop and execute effective care management programs

• Track and manage provider performance related to open care gaps across the network

INSIGHTS FOR ACTION

SCIO delivers value- based performance insights to providers across patient populations:• Medicare Advantage• Medicare Fee for Service• MSSP ACO• Medicaid • Commercial

View provider group performance across the network to spot outliers, trends and opportunities to improve quality measure performance.

IMPROVE QUALITY MEASURE COMPLIANCE

• Drive compliance of quality measures across your provider network by identifying providers who are meeting quality metrics & reveal opportunities to improve compliance (HEDIS, Stars, P4P, etc.)

• Identify quality measure gaps and compliance rates across the population

4

OPTIMIZING REVENUE & RISK

As providers strive to better manage their at-risk populations, they need actionable intelligence to make strategic decisions, fast.

SCIO helps create a single view of data across payers in order to:

VALIDATE ACCURATE PAYMENTS

Risk adjustment scores and quality measures are critical factors in optimizing revenue for providers. SCIO harnesses the data that drives CMS risk adjusted methodologies in order to:

• Align revenue with expected costs of care

• Identify patients and providers with likely documentation issues via preconfigured suspect lists

• Ensure patients with histories of chronic conditions have care and documentation gaps closed each year

• Support retrospective and prospective gap closure tactics

• Forecast and measure program progress

INSIGHTS FOR ACTION

Identify patients with previously documented chronic conditions, who are missing condition codes for the current year.

MANAGE POPULATION RISK

In order to help provider organizations meet cost and quality targets, SCIO partners with clients to:

IDENTIFY & STRATIFY POPULATION RISK

• Understand and risk-stratify patient populations by cost, quality, utilization and documentation history to prioritize interventions

IDENTIFY OPPORTUNITIES FOR PROACTIVE & EFFECTIVE INTERVENTIONS

• Drive better care by identifying and monitoring patients with chronic conditions

• Identify the most impactable patients, those who will have the highest financial impact if care gaps are closed

5

• Further stratify patients by intervenability, or those most likely to comply with given interventions

• Intervene earlier to treat preference sensitive conditions

• Implement effective care management programs

MONITOR PROGRESS, OUTCOMES & PROGRAM EFFECTIVENESS

• Measure and track program outcomes to see impact over time, and set and track goals toward program effectiveness

PROVIDER NETWORK MANAGEMENT

From costs to quality to provider efficiency, managing a network of providers requires a clear line of sight into network operations. SCIO helps network managers:

TRACK & MEASURE PROVIDER PERFORMANCE ACROSS:

COST, QUALITY, EFFICIENCY & UTILIZATION

• Measure risk-adjusted provider efficiency to make like-for-like comparisons between groups and individuals

• Spot outliers in order to intervene and address root causes

• Steer patient care towards in-network top performers

• Understand cost drivers across the network, drivers of those costs and opportunities for improvements

• Identify and evaluate network leakage

• Track provider quality performance to understand which providers are meeting quality measures and those who are not

INSIGHTS FOR ACTION

Gain insight into key performance trends across your provider network related to referral patterns and network leakage.

SCIO’s advanced Impactability model allows for quick identification of

populations who will deliver the highest financial impact

if care gaps are closed

6

THE SCIO APPROACHSCIO takes an outcomes focused approach to delivering insights-as-a-service to clients. Our SCIOXpert™ consultants work with your organization to identify your needs and collaborate to determine the best path forward. Our services delivery model leverages proven analytic models and technology platforms to provide insights in the formats that suit our clients’ needs – from prioritized patient lists – to fully visualized reports – to self-service analytics tools – and any combination in between.

As part of our insights-as-a-service model, SCIO will aggregate all available clinical, financial, and economic behavioral data on a HIPAA-compliant analytics platform. An organization’s data sources can be complemented by SCIO’s social demographic data (eg, “ZIP +4”) to generate full patient and provider profiles.

Once the data is standardized, SCIO leverages advanced predictive and prescriptive analytic models to generate insights for clients. These insights provide unique views across the population that help our clients minimize risks, prioritize resources, drive quality and reach value-based care delivery goals.

DATA TRANSFORMATION DATA PROCESSING & PROFILES

ANALYTICS & MODELING360° VIEW

MULTIPLE & NEW DATA SOURCES

VISUALIZATION & OUTPUT

INSIGHTS-AS-A- SERVICE

7

SCIO’s DNA is healthcare; our energy is dedicated to using analytics to solve challenges specifically in the healthcare domain. SCIO has over 14+ years of experience partnering with clients to help manage risk-based programs and is a leader in leveraging analytics to drive outcomes, modify behavior, and increase efficiency.

A few key reasons clients look to SCIO as a strategic partner to their business:

WHY SCIO

TRUSTED EXPERTISE

RAPID INNOVATION

PROVEN IMPACT

DELIVERY

Clinical, technology, analytics and claim auditing. Cross continuum experience

and best practice.

Flexible and scalable solutions.

Actionable insights to drive outcomes and quantifiable savings.

Flexible models and systematic approach

enabled by technology and global resources.

1. Healthcare Exec: C-suite expects to reach value-based care tipping point by2020: http://www.healthexec.com/topics/leadership/c-suite-expects-reach-value-based-care-tipping-point-2020

2. Forbes: UnitedHealth, Aetna, Anthem Near 50% Value-Based Care Spending:https://www.forbes.com/sites/brucejapsen/2017/02/02/unitedhealth-aetna-anthem-near-50-value-based-care-spending/#30a5e62e1d4e

REFERENCE

433 South Main St., Suite 203

West Hartford, CT 06110

P: 1.800.653.3144

F: 1.860.676.8848

E-mail.: info@SCIOhealthanalytics.com

www.sciohealthanalytics.com

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics solution and

services company. It serves healthcare organizations across the continuum including over 20 provider groups

and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30

countries for 8 of the top 15 global pharmaceutical companies. SCIO® provides predictive analytic solutions and

services that transform data into actionable insights, helping healthcare organizations create the understanding

that drives change through care, network and reimbursement optimization as well as commercial effectiveness.

To learn more, visit www.sciohealthanalytics.com.

Driving positive change in healthcare by delivering actionable insights to solve complicated problems simply and efficiently.

About SCIO Health Analytics®