In the current healthcare environment, understanding per member per month (PMPM) cost drivers, and recognizing opportunities to optimize both reimbursement and patient outcomes, are critical to the financial viability of a healthcare organization. Integrated Health Partnerships (IHP) is an accountable care model that incentivizes healthcare providers to take on more financial accountability for the cost of care for Medicaid patients in Minnesota. Allina Health has three IHP contracts which cover approximately 90,000 members, half of which live within a three-county metro area.
Using its analytics platform made it possible for Allina Health to integrate internal and external data sources to deliver insight into PMPM cost drivers and produce a comprehensive evaluation of the drivers of PMPM payment performance. Coupling this PMPM insight with information from data-driven opportunity analysis has given Allina Health insight into its IHP patient population, supporting informed at-risk contracting and the creation of interventions to decrease the total cost of care and improve both financial and clinical outcomes.