Ensuring Healthcare Vendors Deliver Value

Measuring ROI Through Advanced Analytics

Healthcare technology and related services spend is on the rise in the value-based care marketplace, driven by the increasing number of products available to payers and providers that purportedly lower costs, improve operating performance, and increase revenues. In most cases, the benefits of these products and services are clear, however, data does not always exist to provide quantifiable support for the scope and scale of return on investments (ROI), which can make it difficult for organizations to confidently evaluate new product and service offerings and related contract renewals.

We believe best-in-class healthcare organizations have a structured framework for tracking and assessing their vendors and other service providers, including ensuring that regular updates on ROI are provided and that value is in fact being extracted from the organization’s investments. The challenge for vendors and customers alike is knowing how to develop an ROI model that can be trusted. FTI’s experts work with vendors and their customers to evaluate the impact of healthcare technology products and services, and other value-based care activity, and to develop models that provide data-driven, statistically-sound and repeatable quantifications of performance and return.

How FTI Consulting Can Help

Evaluation of vendor savings and value guarantees and other proposed ROI calculation frameworks
Analysis in support of vendor contract renewal decisions
Analysis of software metadata to uncover value drivers and areas for improved customer performance
Development of data models and reporting to calculate and present ROI across a multitude of dimensions

Our Approach

FTI Consulting is an industry leader in harnessing, analyzing, and extracting value from the vast amounts of enterprise and patient data that exists in the healthcare industry. Our Health Solutions and Data & Analytics experts deploy cutting-edge forensic data analysis, machine learning concepts and statistical testing to help companies define, measure and report ROI internally and to customers and partners.

Our work is supported by our deep knowledge of healthcare operations and managed care contracting and related performance indicators, which allows us to get to the root of what drives value for each unique organization. We have had proven success integrating vendor software metadata and payer and provider data feeds, including risk adjustment and quality data, to assess key population health and financial performance measures (e.g., RAF, HCC Recapture, HEDIS Gap Closure). Our team feeds these industry-standard metrics into our models to provide vendors and their customers.

Our iterative and phased based approach to assessing and calculating ROI is defined below:

Phase I: Execute a system review and Exploratory Data Analysis (EDA) to understand size and scope of available enterprise and patient data
Phase 2: Aggregate, normalize and analyze metadata to develop measurable metrics
Phase 3: Ingest metrics into data models and statistical analyses and iterate scenarios
Phase 4: Review results with stakeholders and transition to client as a leave behind solution

The FTI Consulting Difference

Managed Care Expertise
FTI Consulting’s Managed Care and Government Program experts help healthcare organizations implement and achieve their strategic visions in today’s shifting regulatory and reimbursement environment. Our teams work with both large and small plans, provider groups and other entities in various regions, analyzing data and information encompassing millions of Medicare Advantage, Medicaid and commercial beneficiaries. Our team of clinicians, certified coders, compliance experts and former operators of health plans and provider organizations, provides unparalleled expertise and industry knowledge to address our clients’ most critical challenges.

Data Analytics and Reporting
FTI Consulting’s Data & Analytics team utilizes leading technologies in tandem with our data management and analysis skills to perform advanced analytics on large volumes of data to solve companies’ most pressing and complex issues. Our team works independently to build models and analyses that provide objective results. Because advanced analytics and complex modeling are often required to address issues, we explain the methodology and results in a straight-forward and transparent manner that can be understood by clients and audited by third parties. Additionally, we present results using interactive dashboards and reports tools that support drill-down capabilities. This approach enables users from all levels throughout an organization to leverage enterprise data to take data-driven-action.

The bottom line is that differentiating winners and losers in a highly competitive market can come down to a very small margin, and often the most successful organizations have great operational discipline. Winning companies demand performance and accountability from their organization and their business partners alike and deploy strong vendor management processes which often include the measurement of financial return on technology investments and other outsourced operational initiatives.

From our experience, it is common in the value-based care marketplace for technology and related service providers to quote savings and value guarantees without presenting supporting data and analysis. With deep managed care industry expertise and advanced analytics capabilities, our experts can help your organization bring the value of your investments into focus.

Case Study
Evaluation of NLP Service Value for Provider

Situation
A primary care physician practice engaged in multiple risk-bearing capitation arrangements with regional and national MA plans requested our team’s assistance with the evaluation of a technology vendor’s use of NLP to perform retrospective chart reviews. The practice was considering an expanded project scope with the vendor but needed to understand and feel confident with the ROI data being shared from the initial project.

Our Role
Our Managed Care and Data & Analytics experts pressured-tested the vendor’s results by comparing the practice’s submission and CMS response file data to the vendor’s identified new and unique risk adjusting diagnosis codes. Our analysis detected conditions that had been previously submitted through claims, alternate submission methods, and other specialty practices. We also evaluated the vendor’s approach toward estimating the financial impact that would result from the submission of the new and unique diagnosis codes.

Our Impact

We identified gaps in the data being provided to the vendor for use in its analysis and estimation of financial impact, which was resulting in an overstatement of the project’s total value.
We also challenged several assumptions being used by the vendor in its estimation of financial impact, which was resulting in an overstatement of the project’s total value.
Our review of the initial project’s outcome and resulting estimation of financial impact gave the practice the confidence it needed to expand the scope of its engagement with the vendor, following the adjustment of the original contract to incorporate the findings of our review.

Case Study
Quantification of Population Health Platform ROI for Large Vendor

Situation
A large healthcare technology company specializing in population health reporting engaged our team to complete a Return on Investment (ROI) analysis for several of the company’s largest customers in order to develop a business case for those customers to renew their contracts.

Our Role
To calculate the customer’s ROI, we designed a difference-in-difference estimation framework, measuring performance changes in a treatment and control group at various points in time, to understand the effect provider use of the platform had on key outcomes, and to understand the financial return resulting from these changes in performance. Outlined below is a step-by-step overview of our ROI calculation:

Study Platform Usage – Analyze provider-specific platform interaction frequency and volume, and set meaningful use thresholds/levels (e.g., platform reports viewed in over 90% of eligible weeks)
Determine Platform Impact – Understand where value is extracted and identify opportunities for measurement (e.g., HCC Recapture rate performance)
Set a Baseline – Evaluate performance in key measurement areas before platform adoption
Measure Change in Performance – Track performance change following platform adoption
Compare Across Usage Levels – Identify difference in performance between users and non-users of platform, and across usage levels (i.e., Difference in Differences causal inference)
Understand Confounding Variables – Assess differences in provider mix across usage levels and control for differences through application of additional statistical framework, as needed
Calculate Platform ROI – Estimate financial impact associated with platform user performance (e.g., value incremental HCC recapture)
Estimate Full Opportunity – Extrapolate financial impact to additional providers using adoption growth scenarios

Our Impact
FTI Consulting’s analysis was provided to one of the vendor’s largest customers as the primary business case presented to the customer to support renewal and attract equity investment.

We developed a comprehensive and automated reporting package encompassing our ROI analyses and other key performance indicators, which was shared with the customer on a periodic basis to demonstrate continued value from their investment.

We also developed a leave behind clustering and machine learning tool that enabled the customer to segment providers and create patient cohorts for targeting and scheduling. The tool was built from available membership and claim data.

Case Study
Provider Group Value-Based Care Contract Retention

Situation
A leading specialty physician practice retained our team to perform an assessment of the practice’s average cost of care relative to the prevailing rates charged by competitors in its same geographies. The practice wanted to quantify the value being delivered to plans and employers, who were engaged in risk-bearing relationships with the practice, from the direction of patients to the practice for certain high-cost procedures.

Our Role
We utilized commercial outpatient claims data from the Truven MarketScan® database to determine, for each geography of interest, the prevailing fees at the 25th, 50th, and 75th percentiles for the client’s top CPT codes. We then analyzed the practice’s internal data to identify its average cost of care and the relative difference between the geography benchmarks.

Our Impact
We created a framework and reporting structure the practice could utilize to attract new clients and retain and expand existing value-based care relationships. We also identified potential expansion opportunities for the practice (i.e., new locations in which to establish practices) where prevailing costs were higher than the practice’s average.