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Claims Analytics

HOPCo’s claims analytics services are best practices for evaluating claims data to improve performance.

In a time of value-based healthcare, HOPCo offers the claims analytics support necessary to enhance your data collection and analysis, influence your clinical decision making, and develop successful bundled payment programs.

Our proven decision support tools guide physicians to choose the right procedure at the right time for the best results. Our tools identify patients who may be at risk for complications due to other co-morbidities in order to implement interventions.

HOPCo has developed unique and successful partnerships between physicians and health systems to evaluate claims analytics to increase efficiency and reduce costs for orthopedic care. In these programs we help design and take capitated claims risk. With real time access to medical records data, we can continually identify opportunities to cover costs and improve care.

About claims analytics

Claims analytics in healthcare, also called predictive modeling, pulls together claims and cost data, clinical data and patient outcomes. The evaluation of these data sets provides vital information to improve clinical care and patient well-being. The potential benefits for hospitals and physician practices include proven clinical decision support, reduced administrative costs, better care coordination and improved patient outcomes.

For example, when evaluating costs for a total hip replacement, claims analytics experts review costs and outcomes for this patient population. The results can guide physicians in determining the best procedure to be performed at the best location to achieve the best outcomes. This can help physicians identify potentially high-risk patients who may require additional interventions to achieve the desired outcomes. Thus, creating a model for a patient population improves performance, reduces costs and results in the best possible results for the patient.